MEDICARE: MR. ERIC MICHAEL MILLARD

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	7237	CA

General Provider Information

NPI Number	:	1417691262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MICHAEL MILLARD

Provider Business Mailing Address
First Line	:	17216 SATICOY ST # 141
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17037 CHATSWORTH ST STE 100
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5881
Country	:	US
Telephone Number	:	818-206-9992
Fax Number	:

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

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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