Provider Demographics
NPI:1407394539
Name:HARRIS, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RICH HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64779-2042
Mailing Address - Country:US
Mailing Address - Phone:417-395-4191
Mailing Address - Fax:
Practice Address - Street 1:703 N 3RD ST
Practice Address - Street 2:
Practice Address - City:RICH HILL
Practice Address - State:MO
Practice Address - Zip Code:64779-2042
Practice Address - Country:US
Practice Address - Phone:417-395-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist