Provider Demographics
NPI:1114238201
Name:HARRIS, KAREN EILEEN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:EILEEN
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 1:10 WENDOM RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4410
Mailing Address - Country:US
Mailing Address - Phone:518-869-5177
Mailing Address - Fax:
Practice Address - Street 1:10 WENDOM RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4410
Practice Address - Country:US
Practice Address - Phone:518-869-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004738-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004738-1OtherNYS EDUCATION DEPARTMENT REGISTRATION