Provider Demographics
NPI:1982963781
Name:MILLER, CALLIE MONTANA
Entity Type:Individual
Prefix:MISS
First Name:CALLIE
Middle Name:MONTANA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 CHOCTAW TRAIL
Mailing Address - Street 2:
Mailing Address - City:DEQUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832
Mailing Address - Country:US
Mailing Address - Phone:870-584-7864
Mailing Address - Fax:
Practice Address - Street 1:194 CHOCTAW TRAIL
Practice Address - Street 2:
Practice Address - City:DEQUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-584-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251300000X2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187548795OtherPRACTIONER ID NUMBER
AR10-0115OtherMEDICAID REGISTRATION NUMBER