Provider Demographics
NPI:1720213937
Name:MILLER, MICHELLE KRISTINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N UNION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2283
Mailing Address - Country:US
Mailing Address - Phone:719-522-1080
Mailing Address - Fax:719-522-0661
Practice Address - Street 1:1901 N UNION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2283
Practice Address - Country:US
Practice Address - Phone:719-522-1080
Practice Address - Fax:719-522-0661
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12095156OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION