Provider Demographics
NPI:1164655262
Name:MILLER, MELVIN DARRELL (PHD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:DARRELL
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8642
Mailing Address - Country:US
Mailing Address - Phone:208-377-0019
Mailing Address - Fax:208-377-0313
Practice Address - Street 1:1084 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8642
Practice Address - Country:US
Practice Address - Phone:208-377-0019
Practice Address - Fax:208-377-0313
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1422231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1581432Medicare PIN