Provider Demographics
NPI:1609509082
Name:MILLER, CATHERINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:
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:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:BOCA GRANDE
Mailing Address - State:FL
Mailing Address - Zip Code:33921-1617
Mailing Address - Country:US
Mailing Address - Phone:937-546-7148
Mailing Address - Fax:
Practice Address - Street 1:950 PALM AVE
Practice Address - Street 2:224
Practice Address - City:BOCA GRANDE
Practice Address - State:FL
Practice Address - Zip Code:33921
Practice Address - Country:US
Practice Address - Phone:937-546-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist