Provider Demographics
NPI:1568508711
Name:MILLER, ELIZABETH EISERMAN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EISERMAN
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 1:18708 GREYTON LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7807
Mailing Address - Country:US
Mailing Address - Phone:847-208-7783
Mailing Address - Fax:
Practice Address - Street 1:18708 GREYTON LN
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7807
Practice Address - Country:US
Practice Address - Phone:847-208-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2852-154235Z00000X
NC9433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist