Provider Demographics
NPI:1962843920
Name:MILLER, SHEA CHANDLER (MAED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:CHANDLER
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 COVE LAKE DR
Mailing Address - Street 2:APARTMENT 624
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6420
Mailing Address - Country:US
Mailing Address - Phone:550-264-8007
Mailing Address - Fax:
Practice Address - Street 1:175 W LOWRY LN
Practice Address - Street 2:#104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist