MEDICARE: CHRISTINE MARIE MILLER MS., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	12757	OR

General Provider Information

NPI Number	:	1144497074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE MILLER MS., CCC-SLP

Provider Business Mailing Address
First Line	:	4145 SE COOPER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-7755
Country	:	US
Telephone Number	:	503-951-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 NW RALEIGH ST
Second Line	:	SUITE 318
City	:	PORTLAND
State	:	OR
Zip	:	97209-1753
Country	:	US
Telephone Number	:	503-224-2820
Fax Number	:

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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