Basic Information
| Provider Information | |||||||||
| NPI: | 1972905818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | ELLIE | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | ANDRUS | ||||||||
| OtherFirstName: | ELLIE | ||||||||
| OtherMiddleName: | GRACE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1316 MORTEN ST | ||||||||
| Address2: | APT #201 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452082759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177075218 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 CLERMONT CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451031990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137358300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2015011 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.