Provider Demographics
NPI:1609007574
Name:MILLER, TAMALA RAE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMALA
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 APRIL WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7509
Mailing Address - Country:US
Mailing Address - Phone:270-746-6457
Mailing Address - Fax:
Practice Address - Street 1:348 APRIL WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7509
Practice Address - Country:US
Practice Address - Phone:270-746-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3482OtherSLP LICENSING BOARD OF KENTUCKY