Provider Demographics
NPI:1588704977
Name:CAPONE MILLER, KRISTY THERESE (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:THERESE
Last Name:CAPONE 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 1:14 HIGH HILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2434
Mailing Address - Country:US
Mailing Address - Phone:631-671-9319
Mailing Address - Fax:
Practice Address - Street 1:14 HIGH HILL DR
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2434
Practice Address - Country:US
Practice Address - Phone:631-671-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015883-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist