Provider Demographics
NPI:1326082504
Name:MCMILLAN, JEANNE KAY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JEANNE
Middle Name:KAY
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 E 300 N
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8652
Mailing Address - Country:US
Mailing Address - Phone:765-285-8176
Mailing Address - Fax:765-285-5623
Practice Address - Street 1:BALL STATE UNIVERSITY - SPEECH PATHOLOGY AND AUDIO
Practice Address - Street 2:AC109B
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-285-8176
Practice Address - Fax:765-285-5623
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-6000221Medicaid