Healthcare Provider Details

I. General information

NPI: 1699542258
Provider Name (Legal Business Name): JENNIFER CHRISTINE MILLER M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE PL
RICHMOND VA
23233-7336
US

IV. Provider business mailing address

2407 FLOYD AVE APT 3
RICHMOND VA
23220-4449
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4700
  • Fax:
Mailing address:
  • Phone: 615-306-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202007761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: