Basic Information
| Provider Information | |||||||||
| NPI: | 1427651728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796054603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257933400 | ||||||||
| FaxNumber: | 3257933587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1628 19TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067761172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2020 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 115571 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 115571 | 01 | TX | COMMERCIAL | OTHER | 115571 | 05 | TX | MEDICAID |