Provider Demographics
NPI:1104557610
Name:CAIN, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:CAIN
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 1:1675 VERNON ST UNIT 32
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3967
Mailing Address - Country:US
Mailing Address - Phone:847-757-5186
Mailing Address - Fax:
Practice Address - Street 1:3333 VACA VALLEY PKWY STE 900
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9419
Practice Address - Country:US
Practice Address - Phone:707-474-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation