Provider Demographics
NPI:1174061675
Name:MILLER, ANNE (PHD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JOHN HARPER RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:PIONEER VILLAGE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7463
Mailing Address - Country:US
Mailing Address - Phone:502-504-5231
Mailing Address - Fax:502-504-5205
Practice Address - Street 1:815 JOHN HARPER RD UNIT 13
Practice Address - Street 2:
Practice Address - City:PIONEER VILLAGE
Practice Address - State:KY
Practice Address - Zip Code:40165-7463
Practice Address - Country:US
Practice Address - Phone:502-504-5231
Practice Address - Fax:502-504-5205
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129107103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical