Provider Demographics
NPI:1841039922
Name:MILLER, HOLLY KATHLEEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:KATHLEEN
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 1:16935 N WESSEX LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4103
Mailing Address - Country:US
Mailing Address - Phone:775-397-6193
Mailing Address - Fax:
Practice Address - Street 1:412 S KING AVE STE 103
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5294
Practice Address - Country:US
Practice Address - Phone:208-654-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-6405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist