Provider Demographics
NPI:1679821631
Name:HARRISON, ZOE ALINE
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:ALINE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7971 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9148
Mailing Address - Country:US
Mailing Address - Phone:503-930-8557
Mailing Address - Fax:
Practice Address - Street 1:4600 25TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0338
Practice Address - Country:US
Practice Address - Phone:503-373-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker