Provider Demographics
NPI:1306187091
Name:HARRIS, KATILYA GENIECE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATILYA
Middle Name:GENIECE
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 1:3453 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-9286
Mailing Address - Country:US
Mailing Address - Phone:601-624-0242
Mailing Address - Fax:
Practice Address - Street 1:3453 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-9286
Practice Address - Country:US
Practice Address - Phone:601-624-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist