Provider Demographics
NPI:1538707906
Name:MILLER, MANDY RODABOUGH
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:RODABOUGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21934 N 106TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5724
Mailing Address - Country:US
Mailing Address - Phone:623-217-8719
Mailing Address - Fax:
Practice Address - Street 1:8765 W KELTON LN STE 116
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5008
Practice Address - Country:US
Practice Address - Phone:623-977-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant