Provider Demographics
NPI:1043213937
Name:MILLER, KIMBERLY (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 CORRALES RD NW
Mailing Address - Street 2:STE E5A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4532
Mailing Address - Country:US
Mailing Address - Phone:505-890-0003
Mailing Address - Fax:
Practice Address - Street 1:10200 CORRALES RD NW
Practice Address - Street 2:STE E5A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4532
Practice Address - Country:US
Practice Address - Phone:505-890-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3598231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner