MEDICARE: CHARISSA MILLER

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	107864	TX

General Provider Information

NPI Number	:	1881042992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA MILLER

Provider Business Mailing Address
First Line	:	PO BOX 270431
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75027-0431
Country	:	US
Telephone Number	:	972-874-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 LONG PRAIRIE RD STE D
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4960
Country	:	US
Telephone Number	:	972-874-9400
Fax Number	:

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “ CHARISSA MILLER ” Practice Location

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