Provider Demographics
NPI:1093023814
Name:HARRIS, CELESTE MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14271 MATISSE AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1820
Mailing Address - Country:US
Mailing Address - Phone:949-293-2422
Mailing Address - Fax:
Practice Address - Street 1:16269 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3603
Practice Address - Country:US
Practice Address - Phone:949-788-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist