Provider Demographics
NPI:1144497074
Name:MILLER, CHRISTINE MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MILLER
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 1:4145 SE COOPER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7755
Mailing Address - Country:US
Mailing Address - Phone:503-951-0348
Mailing Address - Fax:
Practice Address - Street 1:1722 NW RALEIGH ST
Practice Address - Street 2:SUITE 318
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1753
Practice Address - Country:US
Practice Address - Phone:503-224-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist