Provider Demographics
NPI:1538588173
Name:MILLER, ALYSSA ATCHINSON (SLP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ATCHINSON
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-4402
Mailing Address - Country:US
Mailing Address - Phone:518-647-5503
Mailing Address - Fax:
Practice Address - Street 1:28 CHURCH LN
Practice Address - Street 2:
Practice Address - City:AU SABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912-4402
Practice Address - Country:US
Practice Address - Phone:518-647-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014200-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist