Provider Demographics
NPI:1750536637
Name:MILLER, MYRALYN A (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MYRALYN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COLLEGE DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7683
Mailing Address - Country:US
Mailing Address - Phone:904-537-3629
Mailing Address - Fax:904-272-6859
Practice Address - Street 1:151 COLLEGE DR
Practice Address - Street 2:SUITE #6
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7683
Practice Address - Country:US
Practice Address - Phone:904-537-3629
Practice Address - Fax:904-272-6859
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist