MEDICARE: CARLY MILLER 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	SP-3184	NV

General Provider Information

NPI Number	:	1770221442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY MILLER SLP

Provider Business Mailing Address
First Line	:	6363 S PECOS RD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6291
Country	:	US
Telephone Number	:	702-565-5011
Fax Number	:	702-565-5012

Provider Business Practice Location Address
First Line	:	6363 S PECOS RD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6291
Country	:	US
Telephone Number	:	702-565-5011
Fax Number	:	702-565-5012

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

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ CARLY MILLER SLP” Practice Location

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