Provider Demographics
NPI:1275574485
Name:MILLER, GABRIELLE JUDITH (MS-CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:JUDITH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5623
Mailing Address - Country:US
Mailing Address - Phone:781-431-7868
Mailing Address - Fax:
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7768
Practice Address - Country:US
Practice Address - Phone:781-431-8857
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist