Provider Demographics
NPI:1326717265
Name:HARRIS, JODIE G (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 KEYSBURG CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7786
Mailing Address - Country:US
Mailing Address - Phone:808-387-0857
Mailing Address - Fax:
Practice Address - Street 1:2226 MURPHY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2549
Practice Address - Country:US
Practice Address - Phone:808-387-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist