Provider Demographics
NPI:1659682730
Name:MILLER, KRISTINA LEE (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SKY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046-1511
Mailing Address - Country:US
Mailing Address - Phone:630-779-6065
Mailing Address - Fax:
Practice Address - Street 1:7105 SKY MEADOW DR
Practice Address - Street 2:
Practice Address - City:COLLEGE GROVE
Practice Address - State:TN
Practice Address - Zip Code:37046-1511
Practice Address - Country:US
Practice Address - Phone:630-779-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010682235Z00000X
TN8050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8050Medicaid