Provider Demographics
NPI:1487227575
Name:MILLER, MITZI NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:NICOLE
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 1:101 TARA OAK DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5776
Mailing Address - Country:US
Mailing Address - Phone:337-305-3544
Mailing Address - Fax:
Practice Address - Street 1:101 TARA OAK DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5776
Practice Address - Country:US
Practice Address - Phone:337-305-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP12950235Z00000X
LA6108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty