Healthcare Provider Details

I. General information

NPI: 1003710161
Provider Name (Legal Business Name): JENNIFER LEE MILLER MS, CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 AVIATION RD
QUEENSBURY NY
12804-2914
US

IV. Provider business mailing address

30 CANTERBURY RD
CLIFTON PARK NY
12065-1704
US

V. Phone/Fax

Practice location:
  • Phone: 518-824-5699
  • Fax:
Mailing address:
  • Phone: 518-428-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number037-085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: