Active NPI
Brooke Miller, MSW
- Clinical Social Worker
- Forest Grove, OR
National Provider Identifier
1669679783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L4757
- Practice address
- 4110 Pacific Ave
Suite 102
Forest Grove, OR 97116-2383 - Phone
- (503) 601-5400
- Fax
- (503) 601-5410
- NPI assigned
- Jul 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ASW 17574 | CA | |
| Clinical Social Worker | 1041C0700X | L4757 | OR | Primary |
Addresses
Primary practice location
4110 Pacific Ave
Suite 102
Forest Grove, OR 97116-2383
Mailing address
4110 Pacific Ave
Suite 102
Forest Grove, OR 97116-2383
Phone (503) 601-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW 17574 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408924800000",
"number": "1669679783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4110 PACIFIC AVE",
"address_2": "SUITE 102",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971162383",
"telephone_number": "503-601-5400",
"fax_number": "503-601-5410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 PACIFIC AVE",
"address_2": "SUITE 102",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971162383",
"telephone_number": "503-601-5400",
"fax_number": "503-601-5410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "BROOKE",
"name_prefix": "Ms.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-02",
"last_updated": "2014-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW 17574",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L4757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.