Provider Demographics
NPI:1588870398
Name:MILLER, SUSAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
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 1:21208 75TH AVE
Mailing Address - Street 2:APT. 2G
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3362
Mailing Address - Country:US
Mailing Address - Phone:718-776-4185
Mailing Address - Fax:
Practice Address - Street 1:21208 75TH AVE
Practice Address - Street 2:APT. 2G
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3362
Practice Address - Country:US
Practice Address - Phone:718-776-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012612-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist