Provider Demographics
NPI:1295001360
Name:MILLER, SHANNA MARIE (MA, MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, MS, CCC-SLP
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8614 CARMEL ROSE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015
Mailing Address - Country:US
Mailing Address - Phone:210-865-5653
Mailing Address - Fax:
Practice Address - Street 1:8614 CARMEL ROSE
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015
Practice Address - Country:US
Practice Address - Phone:210-865-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist