Provider Demographics
NPI:1346091527
Name:HARRIS, CHELSEA RAE (HIS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAE
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 1:1715 N LYNN RIGGS BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3056
Mailing Address - Country:US
Mailing Address - Phone:918-341-5088
Mailing Address - Fax:
Practice Address - Street 1:1715 N LYNN RIGGS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3056
Practice Address - Country:US
Practice Address - Phone:918-341-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHADF1411237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist