Provider Demographics
NPI:1982146833
Name:MILLER, CADY
Entity Type:Individual
Prefix:
First Name:CADY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CADY
Other - Middle Name:REBECCA
Other - Last Name:HENNINGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3408 CLAYTON RD E STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7382
Mailing Address - Country:US
Mailing Address - Phone:817-201-4268
Mailing Address - Fax:
Practice Address - Street 1:3408 CLAYTON RD E STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7382
Practice Address - Country:US
Practice Address - Phone:817-201-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist