MEDICARE: KRISTINA LEE MILLER M.S.

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	146010682	IL
2	235Z00000X	Speech-Language Pathologist	8050	TN

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	:	1659682730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA LEE MILLER M.S.

Provider Business Mailing Address
First Line	:	7105 SKY MEADOW DR
Second Line	:
City	:	COLLEGE GROVE
State	:	TN
Zip	:	37046-1511
Country	:	US
Telephone Number	:	630-779-6065
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 SKY MEADOW DR
Second Line	:
City	:	COLLEGE GROVE
State	:	TN
Zip	:	37046-1511
Country	:	US
Telephone Number	:	630-779-6065
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	01/25/2024

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