Provider Demographics
NPI:1578115606
Name:MILLER, SCOTT SELLERS
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:SELLERS
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-6909
Mailing Address - Country:US
Mailing Address - Phone:916-721-0400
Mailing Address - Fax:916-721-0434
Practice Address - Street 1:8041 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-6909
Practice Address - Country:US
Practice Address - Phone:916-721-0400
Practice Address - Fax:916-721-0434
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8019237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist