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General NPI Number Information
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NPI Number | 1760676845
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Entity Type | Organization
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Legal Business Name | STEWART MILLER INSTITUTE FOR EXCELLENCE, INC.
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 151 COLLEGE DR STE 6
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City | ORANGE PARK
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State | FL
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Zip | 32065-7683
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Country | US
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Telephone | 904-537-3629
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Fax | 904-272-6859
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Provider Business Mailing Address
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Address Line | 410 BLANDING BLVD STE 9 #303
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City | ORANGE PARK
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State | FL
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Zip | 32073-5065
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Country | US
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Telephone | 904-537-3629
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Fax | 904-272-6859
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Authorized Official
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Title or Position | PRESIDENT/SPEECH PATHOLOGIST
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Name | MS. MYRALYN A. MILLER
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Credential | MA, CCC-SLP
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Telephone | 904-276-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 893
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License Number State | FL
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