Provider Demographics
NPI:1285305987
Name:MILLER, AUDREY FAYE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:FAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:FAYE
Other - Last Name:REYHONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 S INTERSTATE 35 STE 105
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6646
Mailing Address - Country:US
Mailing Address - Phone:512-310-7665
Mailing Address - Fax:512-310-9228
Practice Address - Street 1:1201 S INTERSTATE 35 STE 105
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6646
Practice Address - Country:US
Practice Address - Phone:512-310-7665
Practice Address - Fax:512-310-9228
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist