Provider Demographics
NPI:1275218950
Name:HARRIS, BRESHEA (HIS)
Entity Type:Individual
Prefix:
First Name:BRESHEA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 S VETERANS BLVD APT 1206
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5778
Mailing Address - Country:US
Mailing Address - Phone:504-799-9575
Mailing Address - Fax:
Practice Address - Street 1:625 S BURNSIDE AVE STE 3
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3400
Practice Address - Country:US
Practice Address - Phone:504-799-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1326237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist