Provider Demographics
NPI:1144576430
Name:HARRIS, IYUNA (MOT)
Entity Type:Individual
Prefix:
First Name:IYUNA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2084
Mailing Address - Country:US
Mailing Address - Phone:773-844-9235
Mailing Address - Fax:
Practice Address - Street 1:19740 GOVERNORS HWY
Practice Address - Street 2:STE 118
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2084
Practice Address - Country:US
Practice Address - Phone:708-799-5569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist