Provider Demographics
NPI:1699177469
Name:HARRIS, PATRICIA GRIMES (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GRIMES
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:TALMADGE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-866-8570
Mailing Address - Fax:901-266-6443
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1762
Practice Address - Country:US
Practice Address - Phone:901-866-8570
Practice Address - Fax:901-266-6443
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist