Provider Demographics
NPI:1649284753
Name:MILLER, REBECCA W (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:W
Last Name:MILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1645
Mailing Address - Country:US
Mailing Address - Phone:814-226-7655
Mailing Address - Fax:814-226-4051
Practice Address - Street 1:180 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1645
Practice Address - Country:US
Practice Address - Phone:814-226-7655
Practice Address - Fax:814-226-4051
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000138L231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001100379001Medicaid
PA000337488OtherHIGHMARK BC/BS
PA0001100379001Medicaid