Provider Demographics
NPI:1528340403
Name:MILLER, JAIMIE T (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JAIMIE
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-1508
Mailing Address - Country:US
Mailing Address - Phone:301-938-1331
Mailing Address - Fax:
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3302
Practice Address - Country:US
Practice Address - Phone:480-472-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009339235Z00000X
WVSLP-1268235Z00000X
VA2202006943235Z00000X
AZSLP11693235Z00000X
OHSP9387235Z00000X
KY3887235Z00000X
MD05930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA235Z00000XOtherTAXONOMY PRODER CODE
AZ235Z00000XMedicaid