Provider Demographics
NPI:1891009544
Name:MILLER, LORISA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORISA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LORISA
Other - Middle Name:MARIE
Other - Last Name:LITTLEJOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4034 RAWLINS ST APT 204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5615
Mailing Address - Country:US
Mailing Address - Phone:214-223-5977
Mailing Address - Fax:
Practice Address - Street 1:2727 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4155
Practice Address - Country:US
Practice Address - Phone:214-223-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist