Provider Demographics
NPI:1821261793
Name:MILLER, SHAYLA SIMONE (MED L-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:SIMONE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WESTWOOD DR
Mailing Address - Street 2:160
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4035
Mailing Address - Country:US
Mailing Address - Phone:225-362-2122
Mailing Address - Fax:318-641-2301
Practice Address - Street 1:103 WESTWOOD DR
Practice Address - Street 2:160
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4035
Practice Address - Country:US
Practice Address - Phone:225-362-2122
Practice Address - Fax:318-641-2301
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist