Provider Demographics
NPI:1710184379
Name:MILLER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 5 AVE
Mailing Address - Street 2:5TH AVE
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442
Mailing Address - Country:US
Mailing Address - Phone:712-263-6978
Mailing Address - Fax:
Practice Address - Street 1:1202 12 AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442
Practice Address - Country:US
Practice Address - Phone:712-263-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist