Provider Demographics
NPI:1336282334
Name:MILLER, LISA ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
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 1:3309 56TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8580
Mailing Address - Country:US
Mailing Address - Phone:253-331-0033
Mailing Address - Fax:
Practice Address - Street 1:3309 56TH ST STE 106
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8580
Practice Address - Country:US
Practice Address - Phone:253-331-0033
Practice Address - Fax:888-613-1087
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALLL00003293235Z00000X
WALL00003293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty