Provider Demographics
NPI:1407013998
Name:HARRIS, LINDA M (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1516
Mailing Address - Country:US
Mailing Address - Phone:845-876-3094
Mailing Address - Fax:845-876-4217
Practice Address - Street 1:55 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1516
Practice Address - Country:US
Practice Address - Phone:845-876-3094
Practice Address - Fax:845-876-4217
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000475231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM1952MW441Medicare PIN