Active NPI
Trevor Miller, MA CCC-SLP
- Speech-Language Pathologist
- Gary, IN
National Provider Identifier
1710645767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22007808A
- Practice address
- 353 Tyler St
Gary, IN 46402-1149 - Phone
- (219) 886-7070
- NPI assigned
- Dec 7, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22007808A | IN | Primary |
Addresses
Primary practice location
353 Tyler St
Gary, IN 46402-1149
Mailing address
7240 Ohio Ave
Hammond, IN 46323-2508
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22007808A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1710645767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7240 OHIO AVE",
"city": "HAMMOND",
"state": "IN",
"postal_code": "463232508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "353 TYLER ST",
"city": "GARY",
"state": "IN",
"postal_code": "464021149",
"telephone_number": "219-886-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "TREVOR",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-07",
"last_updated": "2021-12-07",
"certification_date": "2021-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22007808A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.