Provider Demographics
NPI:1053410852
Name:MILLIGAN, SHARON ILEEN (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ILEEN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 PLAZA DE VIOLA
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650
Mailing Address - Country:US
Mailing Address - Phone:520-378-0808
Mailing Address - Fax:
Practice Address - Street 1:805 E FREEMONT
Practice Address - Street 2:TOMBSTONE UNIFIED SCHOOL DISTRICT #1
Practice Address - City:TOMBSTONE
Practice Address - State:AZ
Practice Address - Zip Code:85638
Practice Address - Country:US
Practice Address - Phone:520-457-2217
Practice Address - Fax:520-457-3270
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ408139Medicaid