Provider Demographics
NPI:1124487533
Name:MILLER, ERIN (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1018
Mailing Address - Country:US
Mailing Address - Phone:407-924-3880
Mailing Address - Fax:
Practice Address - Street 1:720 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1018
Practice Address - Country:US
Practice Address - Phone:407-924-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist