Provider Demographics
NPI:1437393089
Name:MILLER, MELISSA GRACE (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
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 1:3603 ROUND LAKE BLVD NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5057
Mailing Address - Country:US
Mailing Address - Phone:763-450-5434
Mailing Address - Fax:763-450-5431
Practice Address - Street 1:3603 ROUND LAKE BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5057
Practice Address - Country:US
Practice Address - Phone:763-450-5434
Practice Address - Fax:763-450-5431
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2265237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist