Provider Demographics
NPI:1346544137
Name:MILLER, KRISTEN LYNN (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
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 1:38461 PIKE RIVER RD
Mailing Address - Street 2:P.O. BOX 662
Mailing Address - City:CHASSELL
Mailing Address - State:MI
Mailing Address - Zip Code:49916-9470
Mailing Address - Country:US
Mailing Address - Phone:906-370-1514
Mailing Address - Fax:
Practice Address - Street 1:38461 PIKE RIVER RD
Practice Address - Street 2:
Practice Address - City:CHASSELL
Practice Address - State:MI
Practice Address - Zip Code:49916-9470
Practice Address - Country:US
Practice Address - Phone:906-370-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09139486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09139486OtherASHA NUMBER