Provider Demographics
NPI:1346688595
Name:HARRIS, SYDNEY M (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
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 1:1484 E LOCUST VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5810
Mailing Address - Country:US
Mailing Address - Phone:208-367-8989
Mailing Address - Fax:
Practice Address - Street 1:717 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9342
Practice Address - Country:US
Practice Address - Phone:208-367-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist