Provider Demographics
NPI:1639788912
Name:MILLER, LAUREN GRACE (AUD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S DIXIE HWY APT 933
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7329
Mailing Address - Country:US
Mailing Address - Phone:317-956-2099
Mailing Address - Fax:
Practice Address - Street 1:1601 CLINT MOORE RD STE 105&135
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-393-9150
Practice Address - Fax:561-391-5618
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2393237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter