Provider Demographics
NPI:1285867663
Name:MILLER, STACEY (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W 86TH ST
Mailing Address - Street 2:APT 10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3120
Mailing Address - Country:US
Mailing Address - Phone:917-748-0688
Mailing Address - Fax:
Practice Address - Street 1:325 W 86TH ST
Practice Address - Street 2:APT 10C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3120
Practice Address - Country:US
Practice Address - Phone:917-748-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017647-4235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist