Provider Demographics
NPI:1114584828
Name:MILLER, BRITTANIE NICHOLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:NICHOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BUMBLEBEE ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-6710
Mailing Address - Country:US
Mailing Address - Phone:417-699-6491
Mailing Address - Fax:
Practice Address - Street 1:702 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2920
Practice Address - Country:US
Practice Address - Phone:870-204-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200542OtherARKANSAS SPEECH PROVISIONAL LICENSE