Provider Demographics
NPI:1447826409
Name:MILLER, SHARON DENISE (M A CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:DENISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:M A CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WALTER WAY UNIT 1206
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9509
Mailing Address - Country:US
Mailing Address - Phone:171-993-0880
Mailing Address - Fax:
Practice Address - Street 1:1022 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6235
Practice Address - Country:US
Practice Address - Phone:719-930-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist