Individual
SARAH VITTUM MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
820 ELM DR, ST MARIES, ID 83861-2119
(208) 245-4576
(208) 245-2138
Mailing address
PO BOX 579, COCOLALLA, ID 83813-0579
(509) 385-2763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1935
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
IDAHO MEDICAID
ID
05
—
PENDING
—
ID
Enumeration date
06/01/2016
Last updated
06/01/2016
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