Provider Demographics
NPI:1962676288
Name:MILLWARD, MICHELLE RENEE (MA, F-AAA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:MILLWARD
Suffix:
Gender:F
Credentials:MA, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3866
Mailing Address - Country:US
Mailing Address - Phone:972-420-7212
Mailing Address - Fax:972-420-8812
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-420-7212
Practice Address - Fax:972-420-8812
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51323237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter