Provider Demographics
NPI:1528575446
Name:MILLER, ELYSE HOWARD (MAED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:HOWARD
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAED, CCC-SLP
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:HOWARD
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAED, CCC-SLP
Mailing Address - Street 1:123 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1109
Mailing Address - Country:US
Mailing Address - Phone:859-274-6064
Mailing Address - Fax:
Practice Address - Street 1:123 ELM ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1109
Practice Address - Country:US
Practice Address - Phone:859-274-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist