1689735532 NPI number — BEVERLY ELAINE MILLER CCC SLP

Table of content: BEVERLY ELAINE MILLER CCC SLP (NPI 1689735532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689735532 NPI number — BEVERLY ELAINE MILLER CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
BEVERLY
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC SLP
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:
1689735532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#1 JOHN MARSHALL DR
Provider Second Line Business Mailing Address:
MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25755-2675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-696-3641
Provider Business Mailing Address Fax Number:
304-696-2986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 JOHN MARSHALL DR
Provider Second Line Business Practice Location Address:
MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25755-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-696-3641
Provider Business Practice Location Address Fax Number:
304-696-2986
Provider Enumeration Date:
12/13/2006

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: 235Z00000X , with the licence number:  SLP0186 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0154484000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".