Provider Demographics
NPI:1841538618
Name:MILLER, SUSAN SHAPTER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHAPTER
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 RIDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4011
Mailing Address - Country:US
Mailing Address - Phone:817-703-7063
Mailing Address - Fax:
Practice Address - Street 1:121 RIDGEHILL DR
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4011
Practice Address - Country:US
Practice Address - Phone:817-703-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist