Provider Demographics
NPI:1922777564
Name:MILLER, JAVIN RICHARD (CF-SLP)
Entity Type:Individual
Prefix:
First Name:JAVIN
Middle Name:RICHARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 100 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2036
Mailing Address - Country:US
Mailing Address - Phone:435-781-6864
Mailing Address - Fax:
Practice Address - Street 1:75 N 200 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2001
Practice Address - Country:US
Practice Address - Phone:435-781-6864
Practice Address - Fax:435-781-2040
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12448060-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist