Provider Demographics
NPI:1437635844
Name:HARRIS, JENEANNE A (MT)
Entity Type:Individual
Prefix:
First Name:JENEANNE
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WOOD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KINCHELOE
Mailing Address - State:MI
Mailing Address - Zip Code:49788-1108
Mailing Address - Country:US
Mailing Address - Phone:906-322-4898
Mailing Address - Fax:
Practice Address - Street 1:43 WOOD LAKE RD
Practice Address - Street 2:
Practice Address - City:KINCHELOE
Practice Address - State:MI
Practice Address - Zip Code:49788-1108
Practice Address - Country:US
Practice Address - Phone:906-322-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)