Provider Demographics
NPI:1396036703
Name:JB HARRIS SPEECH THERAPY
Entity Type:Organization
Organization Name:JB HARRIS SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-253-4334
Mailing Address - Street 1:3000 IMMOKALEE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1444
Mailing Address - Country:US
Mailing Address - Phone:239-253-4334
Mailing Address - Fax:239-791-1114
Practice Address - Street 1:3000 IMMOKALEE RD STE 7
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1444
Practice Address - Country:US
Practice Address - Phone:239-253-4334
Practice Address - Fax:239-791-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002821600Medicaid
FL000404700Medicaid