Provider Demographics
NPI:1154825370
Name:MILLAN, SAN A (MS, SLP-CF)
Entity Type:Individual
Prefix:
First Name:SAN
Middle Name:A
Last Name:MILLAN
Suffix:
Gender:F
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 LA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4202
Mailing Address - Country:US
Mailing Address - Phone:956-590-3367
Mailing Address - Fax:
Practice Address - Street 1:12770 COIT RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1336
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist