Provider Demographics
NPI:1417259508
Name:HARRIS, ROBERT E (BC-HIS, ACA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4323
Mailing Address - Country:US
Mailing Address - Phone:801-373-6827
Mailing Address - Fax:801-373-6814
Practice Address - Street 1:330 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4323
Practice Address - Country:US
Practice Address - Phone:801-373-6827
Practice Address - Fax:801-373-6814
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0005339018237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist