Provider Demographics
NPI:1861606683
Name:JONES MILLER, SUSAN LYNNE (MACCCA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNNE
Last Name:JONES MILLER
Suffix:
Gender:F
Credentials:MACCCA
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LYNNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MACCCA
Mailing Address - Street 1:12725 ECKEL JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1306
Mailing Address - Country:US
Mailing Address - Phone:419-873-1783
Mailing Address - Fax:419-873-8649
Practice Address - Street 1:12725 ECKEL JUNCTION RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1306
Practice Address - Country:US
Practice Address - Phone:419-873-1783
Practice Address - Fax:419-873-8649
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00661231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2689434Medicaid
OH000000330899OtherANTHEM
Q19741AUDIOLOGISTMedicare UPIN
OH000000330899OtherANTHEM