Provider Demographics
NPI:1174798284
Name:JEANNE K MCMILLAN
Entity type:Organization
Organization Name:JEANNE K MCMILLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:765-285-8176
Mailing Address - Street 1:7270 E 300 N
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8652
Mailing Address - Country:US
Mailing Address - Phone:765-285-8176
Mailing Address - Fax:
Practice Address - Street 1:7270 E 300 N
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-8652
Practice Address - Country:US
Practice Address - Phone:765-285-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty