Provider Demographics
NPI:1033649082
Name:NORRIS, SEAN P (HAD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:NORRIS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 MISHAWAKA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2100
Mailing Address - Country:US
Mailing Address - Phone:574-383-5595
Mailing Address - Fax:574-520-1505
Practice Address - Street 1:2406 MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2100
Practice Address - Country:US
Practice Address - Phone:574-383-5595
Practice Address - Fax:574-520-1505
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001314A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist