Provider Demographics
NPI:1457427270
Name:MILLER, LISA VAL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:VAL
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:PO BOX 3403
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3403
Mailing Address - Country:US
Mailing Address - Phone:907-746-7300
Mailing Address - Fax:907-746-7302
Practice Address - Street 1:7335 E PALMER WASILLA HWY
Practice Address - Street 2:1A
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-7300
Practice Address - Fax:907-746-7302
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK83235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP0172Medicaid