Provider Demographics
NPI:1053716894
Name:MILLER, JASON (SLP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11538
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1538
Mailing Address - Country:US
Mailing Address - Phone:254-245-9178
Mailing Address - Fax:
Practice Address - Street 1:101B W CENTRAL TEXAS EXPY STE D
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1704
Practice Address - Country:US
Practice Address - Phone:254-630-1186
Practice Address - Fax:254-630-9235
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist