Provider Demographics
NPI:1104071372
Name:MILLS, JANIS ELLYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:ELLYN
Last Name:MILLS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7030
Mailing Address - Country:US
Mailing Address - Phone:845-425-4370
Mailing Address - Fax:845-425-4370
Practice Address - Street 1:42 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7030
Practice Address - Country:US
Practice Address - Phone:845-425-4370
Practice Address - Fax:845-425-4370
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist