Provider Demographics
NPI:1184928053
Name:MILES-FAHS, MARGARET ELLEN (ASHA/CCC/SP,NY LIC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:MILES-FAHS
Suffix:
Gender:F
Credentials:ASHA/CCC/SP,NY LIC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELLEN
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS/TSHH, MA SPEECH
Mailing Address - Street 1:7 W ROYAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1654
Mailing Address - Country:US
Mailing Address - Phone:716-472-9651
Mailing Address - Fax:716-771-1551
Practice Address - Street 1:333 CLINTON ST
Practice Address - Street 2:ROOM 16
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1756
Practice Address - Country:US
Practice Address - Phone:716-816-4393
Practice Address - Fax:716-816-1711
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58004774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01060657-02OtherASHA CERTICATION NUMBER/ACCOUNT : UNITED STATES