Healthcare Provider Details

I. General information

NPI: 1871528596
Provider Name (Legal Business Name): MARY MILLER PHD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16038 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

16038 DOCTORS BLVD
HAMMOND LA
70403-1478
US

V. Phone/Fax

Practice location:
  • Phone: 985-419-8080
  • Fax: 985-542-0282
Mailing address:
  • Phone: 985-419-8080
  • Fax: 985-542-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number5622
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number5622
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5622
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5622
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: