Provider Demographics
NPI:1932355575
Name:MILLER, MIRIAM ROSE (MA- SLP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4105
Mailing Address - Country:US
Mailing Address - Phone:831-419-1508
Mailing Address - Fax:
Practice Address - Street 1:139 2ND ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5102
Practice Address - Country:US
Practice Address - Phone:831-419-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist