Provider Demographics
NPI:1942452032
Name:MILLER, JENNIE YOUNJIN (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:YOUNJIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:YOUN JIN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:35 WINTHROP WOODS RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5025
Mailing Address - Country:US
Mailing Address - Phone:203-954-5592
Mailing Address - Fax:
Practice Address - Street 1:251 E TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2823
Practice Address - Country:US
Practice Address - Phone:914-907-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist