MEDICARE: MAUREEN A MILLER MS CCC-SLP/A

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	6479	SC

General Provider Information

NPI Number	:	1417587049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN A MILLER MS CCC-SLP/A

Provider Business Mailing Address
First Line	:	1130 PYXIE MOSS DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8680
Country	:	US
Telephone Number	:	203-314-0461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 PYXIE MOSS DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8680
Country	:	US
Telephone Number	:	203-314-0461
Fax Number	:

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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Directions to “ MAUREEN A MILLER MS CCC-SLP/A” Practice Location

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