Provider Demographics
NPI:1487183869
Name:MILLIKEN, DREW (HIS)
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 GE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4193
Mailing Address - Country:US
Mailing Address - Phone:309-662-9552
Mailing Address - Fax:
Practice Address - Street 1:261 N BROAD ST STE 57
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4556
Practice Address - Country:US
Practice Address - Phone:309-342-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL037-3029237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist