Provider Demographics
NPI:1497325237
Name:MILLER, ANGIE DAILEY (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:DAILEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 DUNAWAY LN
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:KY
Mailing Address - Zip Code:42027-8326
Mailing Address - Country:US
Mailing Address - Phone:270-210-0262
Mailing Address - Fax:
Practice Address - Street 1:1253 LAKE BARKLEY DR
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055-6124
Practice Address - Country:US
Practice Address - Phone:270-210-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist