1992052484 NPI number — MS. BRENDA FRANCES HARRIS SLP-L

Table of content: MS. BRENDA FRANCES HARRIS SLP-L (NPI 1992052484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992052484 NPI number — MS. BRENDA FRANCES HARRIS SLP-L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
BRENDA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP-L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992052484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18656 DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-323-7057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1807 222ND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUK VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-757-9237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146-005954 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 146-005954 . This is a "IL STATE LICENSE, SPEECH PATHOLOGY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com