Provider Demographics
NPI:1386085405
Name:MILLER, ROLAND WESLEY (BC-HIS, ACA)
Entity type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:WESLEY
Last Name:MILLER
Suffix:
Gender:M
Credentials:BC-HIS, ACA
Other - Prefix:MR
Other - First Name:WESLEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS, ACA
Mailing Address - Street 1:109 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6205
Mailing Address - Country:US
Mailing Address - Phone:575-622-2887
Mailing Address - Fax:575-622-3379
Practice Address - Street 1:109 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6205
Practice Address - Country:US
Practice Address - Phone:575-622-2887
Practice Address - Fax:575-622-3379
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM470A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist