Provider Demographics
NPI:1790256741
Name:MILLER, KELLY ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 CEDAR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-7251
Mailing Address - Country:US
Mailing Address - Phone:859-640-7056
Mailing Address - Fax:
Practice Address - Street 1:6301 BASS RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9384
Practice Address - Country:US
Practice Address - Phone:502-228-8359
Practice Address - Fax:502-228-5469
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist