Provider Demographics
NPI:1174860571
Name:HARRIS, GENA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
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 1:5737 GREENFIELD HWY 54
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-1707
Mailing Address - Country:US
Mailing Address - Phone:731-364-6800
Mailing Address - Fax:
Practice Address - Street 1:5737 GREENFIELD HWY 54
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-1707
Practice Address - Country:US
Practice Address - Phone:731-364-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist