Individual provider Active NPI

Jennifer G Miller, CCC-SLP

  • Speech-Language Pathologist
  • Mesa, AZ
National Provider Identifier
1285688648
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP1202 Issued in AZ
Practice address
1035 N Ellsworth Rd Ste 107
Mesa, AZ 85207-5144
Phone
(602) 628-3798
NPI assigned
May 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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 SLP1202 AZ Primary

Addresses

Primary practice location

1035 N Ellsworth Rd Ste 107
Mesa, AZ 85207-5144

Mailing address

1035 N Ellsworth Rd Ste 107
Mesa, AZ 85207-5144
Phone (602) 628-3798

Other practice location 1

108 W University Dr
Mesa, AZ 85201-5818
Phone (480) 668-1917

Other identifiers 2

IdentifierTypeStateIssuer
AZ0298870OtherAZBCBS NUMBER
525842MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SLP1202AZMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1285688648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 N ELLSWORTH RD STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852075144",
            "telephone_number": "602-628-3798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 N ELLSWORTH RD STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852075144",
            "telephone_number": "602-628-3798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 W University Dr",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852015818",
            "country_code": "US",
            "telephone_number": "480-668-1917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JENNIFER",
        "middle_name": "G",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP1202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "AZ0298870",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "525842",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.