Provider Demographics
NPI:1174877211
Name:JOIE ANN MILETICH
Entity type:Organization
Organization Name:JOIE ANN MILETICH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILETICH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-878-9352
Mailing Address - Street 1:707 HIGHWAY 33 S
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2696
Mailing Address - Country:US
Mailing Address - Phone:218-878-9352
Mailing Address - Fax:218-878-9342
Practice Address - Street 1:707 HIGHWAY 33 S
Practice Address - Street 2:SUITE 9B
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2696
Practice Address - Country:US
Practice Address - Phone:218-878-9352
Practice Address - Fax:218-878-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN168491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty