Provider Demographics
NPI:1548716228
Name:MILLER, CHRISTINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
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 1:1050 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2329
Mailing Address - Country:US
Mailing Address - Phone:219-671-4206
Mailing Address - Fax:
Practice Address - Street 1:11697 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2805
Practice Address - Country:US
Practice Address - Phone:317-284-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004242A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist