Provider Demographics
NPI:1861741316
Name:MILLER, NEITA ANNE (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NEITA
Middle Name:ANNE
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:PO BOX 1021
Mailing Address - Street 2:7 COMANCHE CT.
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-1021
Mailing Address - Country:US
Mailing Address - Phone:505-688-3631
Mailing Address - Fax:505-281-7704
Practice Address - Street 1:1090 MOUNTAIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-8044
Practice Address - Country:US
Practice Address - Phone:505-281-1811
Practice Address - Fax:505-281-7704
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist