Provider Demographics
NPI:1336647726
Name:MILLER, BETH MCKENZIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MCKENZIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33350 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 E 176TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-3109
Practice Address - Country:US
Practice Address - Phone:216-531-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003428235Z00000X
OHSP.12785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.12785OtherOHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
12074483OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
MI7101003428OtherMICHIGAN BOARD OF SPEECH-LANGUAGE PATHOLOGY