Provider Demographics
NPI:1356575773
Name:MILLER, MARTA G (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:G
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 WANDER WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1344
Mailing Address - Country:US
Mailing Address - Phone:847-639-4980
Mailing Address - Fax:
Practice Address - Street 1:6606 WANDER WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-1344
Practice Address - Country:US
Practice Address - Phone:847-639-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist