Healthcare Provider Details

I. General information

NPI: 1962467829
Provider Name (Legal Business Name): JULIE MILES M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD JC-126 AUDIOLOGY
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD JC-126 AUDIOLOGY
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-289-6386
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-289-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2000168369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: