Provider Demographics
NPI:1538444997
Name:MILLER, JENNIFER W (CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:181 HULBURT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2474
Mailing Address - Country:US
Mailing Address - Phone:585-421-2170
Mailing Address - Fax:
Practice Address - Street 1:181 HULBURT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2474
Practice Address - Country:US
Practice Address - Phone:585-421-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist