Individual
SUSAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED., CCC-SLP
Contact information
Practice address
1701 N PATTERSON ST, VALDOSTA, GA 31602-2940
(229) 244-4545
(229) 244-4244
Mailing address
1701 N PATTERSON ST, VALDOSTA, GA 31602-2940
(229) 244-4545
(229) 244-4244
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0004522
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100842
TRADING PARTNER ID
GA
01
—
340257
WELLCARE
GA
Enumeration date
12/29/2006
Last updated
07/08/2007
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