Provider Demographics
NPI:1669079406
Name:MILLER, KAMRYN KELLEY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAMRYN
Middle Name:KELLEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10617 ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2214
Mailing Address - Country:US
Mailing Address - Phone:817-602-9940
Mailing Address - Fax:
Practice Address - Street 1:10617 ESTATE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2214
Practice Address - Country:US
Practice Address - Phone:817-602-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist