Provider Demographics
NPI:1689735532
Name:MILLER, BEVERLY ELAINE (CCC SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials: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:#1 JOHN MARSHALL DR
Mailing Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-2675
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:304-696-2986
Practice Address - Street 1:#1 JOHN MARSHALL DR
Practice Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-2675
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0154484000Medicaid