Individual provider Active NPI

Jennifer K. Miller, CCC-SLP

  • Speech-Language Pathologist
  • Tempe, AZ
National Provider Identifier
1104900653
Registry record updated May 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP5204 Issued in AZ
Practice address
1930 E Southern Ave
Tempe, AZ 85282-7518
Phone
(480) 456-0719
Fax
(480) 456-0163
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP5204 AZ Primary

Addresses

Primary practice location

1930 E Southern Ave
Tempe, AZ 85282-7518

Mailing address

18246 N 15TH PL
Phoenix, AZ 85022-1278
Phone (505) 480-6926

Other identifiers 1

IdentifierTypeStateIssuer
144506MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161018002470 AZ Practitioner - Qualified Speech Language Pathologist 4284922675 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Solace Pediatric Healthcare Therapy Services Az, Inc. Speech-Language Pathologist CurrentSince Jan 22, 2018 Accepting new patients
Therapy One, PLLC Speech-Language Pathologist CurrentSince May 1, 2016 Accepting new patients
Pioneer Pet, LLC Past Accepting new patients

Locations

108 W University Dr
Mesa, AZ 85201
Phone (480) 649-3774

1930 E Southern Ave
Tempe, AZ 85282
Phone (480) 456-0719

60 E Rio Salado Pkwy
Ste 900
Tempe, AZ 85281
Phone (480) 456-0719

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1104900653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18246 N 15TH PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850221278",
            "telephone_number": "505-480-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827518",
            "telephone_number": "480-456-0719",
            "fax_number": "480-456-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JENNIFER",
        "middle_name": "K.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP5204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144506",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.