1457593402 NPI number — MS. MICHELE THERESE MILLER SLP

Table of content: MS. MICHELE THERESE MILLER SLP (NPI 1457593402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457593402 NPI number — MS. MICHELE THERESE MILLER SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
MICHELE
Provider Middle Name:
THERESE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1457593402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 STONE VILLAGE LN NW
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30152-7776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-795-4990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 STONE VILLAGE LN NW STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30152-7778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-426-9915
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2009

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: 235Z00000X , with the licence number:  SLP001704 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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