Individual
MISS CALLIE MONTANA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
194 CHOCTAW TRAIL, DEQUEEN, AR 71832
(870) 584-7864
Mailing address
194 CHOCTAW TRAIL, DEQUEEN, AR 71832
(870) 584-7864
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
251300000X
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-0115
MEDICAID REGISTRATION NUMBER
AR
01
—
187548795
PRACTIONER ID NUMBER
AR
Enumeration date
05/14/2012
Last updated
05/14/2012
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