Provider Demographics
NPI:1760676845
Name:STEWART MILLER INSTITUTE FOR EXCELLENCE, INC.
Entity Type:Organization
Organization Name:STEWART MILLER INSTITUTE FOR EXCELLENCE, INC.
Other - Org Name:TOOLBOX FOR SUCCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRALYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:904-276-1212
Mailing Address - Street 1:410 BLANDING BLVD STE 9
Mailing Address - Street 2:#303
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5065
Mailing Address - Country:US
Mailing Address - Phone:904-537-3629
Mailing Address - Fax:904-272-6859
Practice Address - Street 1:151 COLLEGE DR
Practice Address - Street 2:STE 6
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7683
Practice Address - Country:US
Practice Address - Phone:904-537-3629
Practice Address - Fax:904-272-6859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWART MILLER INSTITUTE FOR EXCELLENCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-31
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty