Provider Demographics
NPI:1215417571
Name:MILLS, DESIREE (SLP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:MILLS
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 1:17911 KINGS PARK LN APT 1704
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3144
Mailing Address - Country:US
Mailing Address - Phone:979-248-6180
Mailing Address - Fax:
Practice Address - Street 1:17231 MILL FOREST RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4308
Practice Address - Country:US
Practice Address - Phone:281-488-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist