Provider Demographics
NPI:1053858902
Name:MILLER, AVERY VICTORIA (MS, SLP-INTERN)
Entity Type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:VICTORIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, SLP-INTERN
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3721 EXECUTIVE CENTER DR
Practice Address - Street 2:#201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1645
Practice Address - Country:US
Practice Address - Phone:512-372-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist