Provider Demographics
NPI:1508276452
Name:MILLER, JILL MARLENE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARLENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA 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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676-0308
Mailing Address - Country:US
Mailing Address - Phone:864-882-1285
Mailing Address - Fax:
Practice Address - Street 1:414 S PINE ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-2146
Practice Address - Country:US
Practice Address - Phone:864-886-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist