MEDICARE: MR. JEANNE KAY MCMILLAN MA, 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	22001571	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326082504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEANNE KAY MCMILLAN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	7270 E 300 N
Second Line	:
City	:	PORTLAND
State	:	IN
Zip	:	47371-8652
Country	:	US
Telephone Number	:	765-285-8176
Fax Number	:	765-285-5623

Provider Business Practice Location Address
First Line	:	1613 W RIVERSIDE AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47306-0001
Country	:	US
Telephone Number	:	765-285-4422
Fax Number	:	765-285-5623

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/29/2024

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Directions to “ MR. JEANNE KAY MCMILLAN MA, CCC-SLP” Practice Location

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