MEDICARE: STEPHANIE ELISABETH MILLER 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	SLP009051	GA

General Provider Information

NPI Number	:	1184136491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELISABETH MILLER CCC-SLP

Provider Business Mailing Address
First Line	:	240 NORTH AVE NE APT 1425
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-4402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 NORTH AVE NE APT 1425
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-4402
Country	:	US
Telephone Number	:	412-417-5144
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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