Provider Demographics
NPI:1457593402
Name:MILLER, MICHELE THERESE (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:THERESE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 STONE VILLAGE LN NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7776
Mailing Address - Country:US
Mailing Address - Phone:770-795-4990
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 202
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7778
Practice Address - Country:US
Practice Address - Phone:770-426-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist