Provider Demographics
NPI:1376809152
Name:MILLS, ROBERT G (BC-HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MILLS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WHISPERING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3757
Mailing Address - Country:US
Mailing Address - Phone:254-715-2698
Mailing Address - Fax:
Practice Address - Street 1:2026 N VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2561
Practice Address - Country:US
Practice Address - Phone:254-715-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80532237700000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist