Provider Demographics
NPI:1740441096
Name:MACMILLAN, LIANE ELIZABETH (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:ELIZABETH
Last Name:MACMILLAN
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 1:1718 TRENT RD
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-6690
Mailing Address - Country:US
Mailing Address - Phone:505-362-1000
Mailing Address - Fax:940-482-8382
Practice Address - Street 1:1718 TRENT RD
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-6690
Practice Address - Country:US
Practice Address - Phone:505-362-1000
Practice Address - Fax:940-482-8382
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist