Provider Demographics
NPI:1043339211
Name:MILLER, TENNILLE JULIA (SLP)
Entity Type:Individual
Prefix:MS
First Name:TENNILLE
Middle Name:JULIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ASTORIA PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4207
Mailing Address - Country:US
Mailing Address - Phone:908-688-0401
Mailing Address - Fax:
Practice Address - Street 1:205 ASTORIA PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4207
Practice Address - Country:US
Practice Address - Phone:908-688-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00542300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist