Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 34004581A | IN |
Y | 1041C0700X | Clinical Social Worker | 34004581A | IN |
NPI | 1003152935 |
---|---|
Provider Name | Kanesha D Miller |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-2040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2012 |
Last Update Date | 15/12/2014 |