Provider Demographics
NPI:1902567092
Name:MILLICAN, CHEYANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-0098
Mailing Address - Country:US
Mailing Address - Phone:432-788-0236
Mailing Address - Fax:
Practice Address - Street 1:105 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3601
Practice Address - Country:US
Practice Address - Phone:432-788-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty