1215174206 NPI number — MS. JACQUELINE CREQUE MILLER MSW

Table of content: ALLISON KATHLEEN RYAN SOLBERG (NPI 1578236493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215174206 NPI number — MS. JACQUELINE CREQUE MILLER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JACQUELINE
Provider Middle Name:
CREQUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215174206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 EAST COMPTON BLVD.
Provider Second Line Business Mailing Address:
DMH SPECIALIZED FOSTER CARE PROGRAM, 1ST FLOOR
Provider Business Mailing Address City Name:
COMPTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-668-6935
Provider Business Mailing Address Fax Number:
310-898-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 E COMPTON BLVD
Provider Second Line Business Practice Location Address:
DMH SPECIALIZED FOSTER CARE PROGRAM, 1ST FLOOR
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-6935
Provider Business Practice Location Address Fax Number:
310-898-1607
Provider Enumeration Date:
01/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS10701 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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