Provider Demographics
NPI:1689414989
Name:MILLER, DANIELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 LAKEVIEW BLVD APT 19
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5486
Mailing Address - Country:US
Mailing Address - Phone:971-804-4100
Mailing Address - Fax:
Practice Address - Street 1:18135 SE BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1099
Practice Address - Country:US
Practice Address - Phone:503-762-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist