Provider Demographics
NPI:1881974632
Name:MILLER, ANN ELIZABETH
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 PINE VIEW PASS
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6517
Mailing Address - Country:US
Mailing Address - Phone:847-356-6553
Mailing Address - Fax:
Practice Address - Street 1:612 PINE VIEW PASS
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6517
Practice Address - Country:US
Practice Address - Phone:847-356-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency