Provider Demographics
NPI:1922702802
Name:MILLER, MARY PAGE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAGE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28520 BLAIR LN
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-2584
Mailing Address - Country:US
Mailing Address - Phone:985-750-1367
Mailing Address - Fax:
Practice Address - Street 1:605 HILLTOP AVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1566
Practice Address - Country:US
Practice Address - Phone:985-839-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist