Provider Demographics
NPI:1700296746
Name:MILLER, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRISTMILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2627
Mailing Address - Country:US
Mailing Address - Phone:434-385-1074
Mailing Address - Fax:434-385-1342
Practice Address - Street 1:305 GRISTMILL DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2627
Practice Address - Country:US
Practice Address - Phone:434-385-1074
Practice Address - Fax:434-385-1342
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.5301 SLP235Z00000X
VA2202001107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist