Provider Demographics
NPI:1306167598
Name:MILLER, CHRISTY LYN (MA-SLP, TSHH)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:LYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1924
Mailing Address - Country:US
Mailing Address - Phone:845-778-8663
Mailing Address - Fax:845-778-8663
Practice Address - Street 1:53 GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1924
Practice Address - Country:US
Practice Address - Phone:845-778-8663
Practice Address - Fax:845-778-8663
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019623-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist