Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.008910 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.008910 | IL |
N | 103G00000X | Clinical Psychologist | 13-01P | AR |
N | 103TC0700X | Clinical Psychologist | 13-01P | AR |
NPI | 1003143637 |
---|---|
Provider Name | Dr. Kim Marie Miiller |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2009 |
Last Update Date | 09/02/2015 |