MEDICARE: HOLLIE MILLICAN

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	TSLP8461	AZ
2	235Z00000X	Speech-Language Pathologist	SP-1949	NV
3	235Z00000X	Speech-Language Pathologist	SP 22983	CA

General Provider Information

NPI Number	:	1972939387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIE MILLICAN

Provider Business Mailing Address
First Line	:	4515 S DURANGO DR
Second Line	:	APT 2012
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6073
Country	:	US
Telephone Number	:	770-880-7935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 S DURANGO DR
Second Line	:	APT 2012
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6073
Country	:	US
Telephone Number	:	770-880-7935
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	11/30/2016

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Directions to “ HOLLIE MILLICAN ” Practice Location

Language	Start Address	Practice Location

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