Provider Demographics
NPI:1619071750
Name:HARRIS, RICHARD WOOD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WOOD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1190 N 900 E
Mailing Address - Street 2:131 TLRB BRIGHAM YOUNG UNIVERSITY
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-8653
Mailing Address - Country:US
Mailing Address - Phone:801-422-6460
Mailing Address - Fax:801-422-0197
Practice Address - Street 1:1190 N 900 E
Practice Address - Street 2:131 TLRB, BRIGHAM YOUNG UNIVERSITY
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3536
Practice Address - Country:US
Practice Address - Phone:801-422-6460
Practice Address - Fax:801-422-0197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105321-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist