MEDICARE: CRYSTAL MILLIEN

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	609739H	WA

General Provider Information

NPI Number	:	1770318024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MILLIEN

Provider Business Mailing Address
First Line	:	1446 ROSS LN N
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-1744
Country	:	US
Telephone Number	:	541-840-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 OLYMPIA WAY
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-4505
Country	:	US
Telephone Number	:	360-545-7630
Fax Number	:

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

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “ CRYSTAL MILLIEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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