Healthcare Provider Details

I. General information

NPI: 1255522462
Provider Name (Legal Business Name): MRS. HAYLIE ANN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAYLIE ANN MUIR M.S.

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CURLEW DR SUITE 5
AMMON ID
83406-4719
US

IV. Provider business mailing address

1619 CURLEW DR SUITE 5
AMMON ID
83406-4719
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-1286
  • Fax: 208-535-1291
Mailing address:
  • Phone: 208-535-1286
  • Fax: 208-535-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP-1642
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: