Provider Demographics
NPI:1831410133
Name:MILLER, ELISABETH E (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:E
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 1:3609 BLUE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-4833
Mailing Address - Country:US
Mailing Address - Phone:314-570-8070
Mailing Address - Fax:
Practice Address - Street 1:3609 BLUE FOREST DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-4833
Practice Address - Country:US
Practice Address - Phone:314-570-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213144301Medicaid
TX213144301Medicaid