MEDICARE: SHANNON MJ MILLER SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	COND.2010076-SP	OH
2	235Z00000X	Speech-Language Pathologist	SP9750	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366774028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MJ MILLER SLP

Provider Business Mailing Address
First Line	:	7291 CONNOR AVE
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-8227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8050 CORPORATE CIR STE 4
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-1281
Country	:	US
Telephone Number	:	440-884-3688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	03/17/2018

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Directions to “ SHANNON MJ MILLER SLP” Practice Location

Language	Start Address	Practice Location

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