Provider Demographics
NPI:1134219900
Name:MILLER, BARBARA SMALLS (MED)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SMALLS
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 RAVENHURST DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5461
Mailing Address - Country:US
Mailing Address - Phone:919-846-8970
Mailing Address - Fax:
Practice Address - Street 1:5860 FARINGDON PL STE 1
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3931
Practice Address - Country:US
Practice Address - Phone:919-871-0520
Practice Address - Fax:919-873-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC46821OtherWELL PATH
NC7458871Medicaid
NC58871OtherBLUE CROSS BLUE SHIELD