| NPI | 1164943601 |
|---|---|
| Former Name | JENNA MARIE MILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP6329) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP6329) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2018-11-05 |