Healthcare Provider Details

I. General information

NPI: 1336052216
Provider Name (Legal Business Name): MICHELLE MILLNER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 BROWNS LAKE RD
JACKSON MI
49201-8379
US

IV. Provider business mailing address

1226 S WISNER ST
JACKSON MI
49203-2864
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-5200
  • Fax:
Mailing address:
  • Phone: 517-867-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: