Provider Demographics
NPI:1417587049
Name:MILLER, MAUREEN A (MS CCC-SLP/A)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 PYXIE MOSS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8680
Mailing Address - Country:US
Mailing Address - Phone:203-314-0461
Mailing Address - Fax:
Practice Address - Street 1:1130 PYXIE MOSS DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8680
Practice Address - Country:US
Practice Address - Phone:203-314-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist