Provider Demographics
NPI:1073732889
Name:MILLER, JENNIFER KUMIKO (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KUMIKO
Last Name:MILLER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KUMIKO
Other - Last Name:MINATODANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2342 HORSEFERRY CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2742
Mailing Address - Country:US
Mailing Address - Phone:703-707-0002
Mailing Address - Fax:703-707-0005
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 235
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:703-707-0002
Practice Address - Fax:703-707-0005
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001282231H00000X
VA2101001599237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist