Provider Demographics
NPI:1952016487
Name:MILLER, MEGAN ELISE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 W WOODS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6082
Mailing Address - Country:US
Mailing Address - Phone:502-572-8838
Mailing Address - Fax:
Practice Address - Street 1:1613 W RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-1012
Practice Address - Country:US
Practice Address - Phone:765-285-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006673A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist