Provider Demographics
NPI:1518013937
Name:MILLER, CAROL R (MNS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MNS, CCC-SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:R
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MNS, CCC-SLP
Mailing Address - Street 1:10702 E ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-8743
Mailing Address - Country:US
Mailing Address - Phone:480-284-7154
Mailing Address - Fax:
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3307
Practice Address - Country:US
Practice Address - Phone:480-472-0727
Practice Address - Fax:480-472-0705
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167362Medicaid