Provider Demographics
NPI:1437466034
Name:MILES, CALI J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CALI
Middle Name:J
Last Name:MILES
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 1:505 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:IL
Mailing Address - Zip Code:61261-9752
Mailing Address - Country:US
Mailing Address - Phone:815-626-5544
Mailing Address - Fax:
Practice Address - Street 1:25799 PROPHET RD
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-9642
Practice Address - Country:US
Practice Address - Phone:815-626-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist