Provider Demographics
NPI:1497969042
Name:MILLER, TAWNI L (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAWNI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7873
Mailing Address - Country:US
Mailing Address - Phone:253-347-2180
Mailing Address - Fax:253-498-0000
Practice Address - Street 1:205 15TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7873
Practice Address - Country:US
Practice Address - Phone:253-347-2180
Practice Address - Fax:253-498-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2069572Medicaid