Provider Demographics
NPI:1962593988
Name:MILLER, MIGNON MARIE (CCC-SLP/A)
Entity type:Individual
Prefix:MRS
First Name:MIGNON
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 COUNTY ROAD V
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6710
Mailing Address - Country:US
Mailing Address - Phone:715-549-9144
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN98G78MIOtherMN BCBS
WI42563700Medicaid
641671046996OtherPREFERRED ONE
7189025OtherAETNA
15665OtherHEALTH PARTNERS
4600765OtherMEDICA