Provider Demographics
NPI:1184976052
Name:MILLER, MICHELLE RENEA
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENEA
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11840 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-9717
Mailing Address - Country:US
Mailing Address - Phone:623-204-6227
Mailing Address - Fax:
Practice Address - Street 1:11840 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-9717
Practice Address - Country:US
Practice Address - Phone:623-204-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA78512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant