MEDICARE: AMBER ELIZABETH MCMILLIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1124534375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ELIZABETH MCMILLIAN

Provider Business Mailing Address
First Line	:	305 NE LOOP 820 STE 200
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-7211
Country	:	US
Telephone Number	:	817-292-8787
Fax Number	:	817-789-6849

Provider Business Practice Location Address
First Line	:	4416 TWIN CITY BLVD
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-5818
Country	:	US
Telephone Number	:	856-383-2878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	12/26/2017

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Directions to “ AMBER ELIZABETH MCMILLIAN ” Practice Location

Language	Start Address	Practice Location

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