Provider Demographics
NPI:1104212596
Name:MILLER, EMILY ELYSE (MACCC SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELYSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MACCC SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELYSE
Other - Last Name:MOORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:4121 KING ROAD
Mailing Address - Street 2:KINGSTON CARE CENTER OF SYLVANIA
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-517-8200
Mailing Address - Fax:419-517-8209
Practice Address - Street 1:4121 KING ROAD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-517-8200
Practice Address - Fax:419-517-8209
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 7982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist