Provider Demographics
NPI:1437300456
Name:PATRICIA A HARRISON INC.
Entity Type:Organization
Organization Name:PATRICIA A HARRISON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:904-386-4990
Mailing Address - Street 1:2594 SPREADING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6501
Mailing Address - Country:US
Mailing Address - Phone:904-386-4990
Mailing Address - Fax:904-260-0435
Practice Address - Street 1:3733 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 208
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2109
Practice Address - Country:US
Practice Address - Phone:904-386-4990
Practice Address - Fax:904-260-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88885911600Medicaid