Provider Demographics
NPI:1528405164
Name:MILLS, JENNY ALINA (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:ALINA
Last Name:MILLS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MS
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:1841 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1309
Mailing Address - Country:US
Mailing Address - Phone:802-338-7941
Mailing Address - Fax:
Practice Address - Street 1:1841 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-1309
Practice Address - Country:US
Practice Address - Phone:802-338-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01118772235Z00000X
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist