Basic Information
| Provider Information | |||||||||
| NPI: | 1164655262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | DARRELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1084 N COLE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770019 | ||||||||
| FaxNumber: | 2083770313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 N COLE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770019 | ||||||||
| FaxNumber: | 2083770313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD-1422 | ID | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | AUD-1422 | ID | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.