Provider Demographics
NPI:1740402445
Name:MCMILLIN, TAMARA E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:E
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17752 S ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8213
Mailing Address - Country:US
Mailing Address - Phone:913-592-3296
Mailing Address - Fax:
Practice Address - Street 1:17752 S ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8213
Practice Address - Country:US
Practice Address - Phone:913-592-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist