Provider Demographics
NPI:1114301579
Name:MILLER, JACKLYN ANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12775 ESCANABA DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8615
Mailing Address - Country:US
Mailing Address - Phone:517-669-8080
Mailing Address - Fax:517-669-8070
Practice Address - Street 1:12775 ESCANABA DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8615
Practice Address - Country:US
Practice Address - Phone:517-669-8080
Practice Address - Fax:517-669-8070
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000710231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist