Provider Demographics
NPI:1518267046
Name:MILLER, CORIN M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORIN
Middle Name:M
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 1:11 HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-9764
Mailing Address - Country:US
Mailing Address - Phone:518-421-4256
Mailing Address - Fax:
Practice Address - Street 1:4645 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3004
Practice Address - Country:US
Practice Address - Phone:866-450-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019755235Z00000X
VA2202006702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist