Provider Demographics
NPI:1811139777
Name:MILLER, JILL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
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 1:2425 POST RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1267
Mailing Address - Country:US
Mailing Address - Phone:203-221-0007
Mailing Address - Fax:
Practice Address - Street 1:2425 POST RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1267
Practice Address - Country:US
Practice Address - Phone:203-221-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist