Provider Demographics
NPI:1548607153
Name:HARRIS, KELLY NEAL
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:NEAL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLASSINGAME RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3304
Mailing Address - Country:US
Mailing Address - Phone:864-355-3100
Mailing Address - Fax:
Practice Address - Street 1:100 BLASSINGAME RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3304
Practice Address - Country:US
Practice Address - Phone:864-355-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist