Provider Demographics
NPI:1003464686
Name:MILLER, SUZANNE RACHEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RACHEL
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 DOUGHTY BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1306
Mailing Address - Country:US
Mailing Address - Phone:845-323-2288
Mailing Address - Fax:
Practice Address - Street 1:999 CENTRAL AVE STE 308
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1205
Practice Address - Country:US
Practice Address - Phone:845-323-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017926-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist