Provider Demographics
NPI:1407525660
Name:MILLER, ALLISON RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CROCKETT ST APT 1539
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3283
Mailing Address - Country:US
Mailing Address - Phone:254-723-4491
Mailing Address - Fax:
Practice Address - Street 1:311 FEATHERSTON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5416
Practice Address - Country:US
Practice Address - Phone:817-202-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist