1104212596 NPI number — EMILY ELYSE MILLER M.A.CCC SLP

Table of content: EMILY ELYSE MILLER M.A.CCC SLP (NPI 1104212596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104212596 NPI number — EMILY ELYSE MILLER M.A.CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
EMILY
Provider Middle Name:
ELYSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.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:
MOORMAN
Provider Other First Name:
EMILY
Provider Other Middle Name:
ELYSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104212596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4121 KING ROAD
Provider Second Line Business Mailing Address:
KINGSTON CARE CENTER OF SYLVANIA
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-517-8200
Provider Business Mailing Address Fax Number:
419-517-8209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4121 KING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-517-8200
Provider Business Practice Location Address Fax Number:
419-517-8209
Provider Enumeration Date:
04/13/2015

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:  SP 7982 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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