Provider Demographics
NPI:1497483994
Name:MILLER, PEYTON ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3116
Mailing Address - Country:US
Mailing Address - Phone:318-880-5683
Mailing Address - Fax:
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP STE 148
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-6114
Practice Address - Country:US
Practice Address - Phone:318-212-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8792OtherLOUISIANA BOARD OF EXAMINERS SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
14362743OtherASHA CERTIFICATION NUMBER