Basic Information
| Provider Information | |||||||||
| NPI: | 1457613101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLARD | ||||||||
| FirstName: | KADY | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 FLINT RD SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356016031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563409708 | ||||||||
| FaxNumber: | 2563409624 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 PINE ST NW | ||||||||
| Address2: | |||||||||
| City: | HARTSELLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356402309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567730138 | ||||||||
| FaxNumber: | 2567730140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235500000X | 3246 | AL | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist |
ID Information
| ID | Type | State | Issuer | Description | 529917620 | 05 | AL | MEDICAID | 1003819608 | 01 | AL | GROUP NPI | OTHER |