Healthcare Provider Details

I. General information

NPI: 1396917407
Provider Name (Legal Business Name): STEPHANIE A MIILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE A SOUKUP

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N WELLNESS DR
HOLLAND MI
49424
US

IV. Provider business mailing address

3100 N WELLNESS DR
HOLLAND MI
49424-8122
US

V. Phone/Fax

Practice location:
  • Phone: 616-994-2770
  • Fax:
Mailing address:
  • Phone: 169-942-7706
  • Fax: 616-920-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number257
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number075863
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: