Provider Demographics
NPI:1114206489
Name:MILLER, ALYSSA DAWN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:DAWN
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 1:21 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-8837
Mailing Address - Country:US
Mailing Address - Phone:406-223-6771
Mailing Address - Fax:
Practice Address - Street 1:21 LOCH LOMOND RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-8837
Practice Address - Country:US
Practice Address - Phone:406-223-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist