Provider Demographics
NPI:1801208020
Name:MILLAGER, RYAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MILLAGER
Suffix:
Gender:M
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 1:275 CAMBRIDGE ST
Mailing Address - Street 2:POB-3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3108
Mailing Address - Country:US
Mailing Address - Phone:617-724-0795
Mailing Address - Fax:617-724-0771
Practice Address - Street 1:275 CAMBRIDGE ST
Practice Address - Street 2:POB-3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3108
Practice Address - Country:US
Practice Address - Phone:617-724-0795
Practice Address - Fax:617-724-0771
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist