Provider Demographics
NPI:1073987996
Name:HARRIS, PAMELA (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11295 CORNELL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2440
Mailing Address - Country:US
Mailing Address - Phone:513-489-6431
Mailing Address - Fax:
Practice Address - Street 1:11295 CORNELL WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2440
Practice Address - Country:US
Practice Address - Phone:513-489-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist