Provider Demographics
NPI:1043885718
Name:NORRIS, JUSTIN LEE (HAS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4501
Mailing Address - Country:US
Mailing Address - Phone:941-492-3600
Mailing Address - Fax:941-492-5656
Practice Address - Street 1:1204 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4501
Practice Address - Country:US
Practice Address - Phone:941-492-3600
Practice Address - Fax:941-492-5656
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5557237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist