Provider Demographics
NPI:1710130265
Name:HARRIS, TRACI A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21638 REED RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5048
Mailing Address - Country:US
Mailing Address - Phone:315-786-0677
Mailing Address - Fax:315-836-3782
Practice Address - Street 1:21638 REED RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5048
Practice Address - Country:US
Practice Address - Phone:315-786-0677
Practice Address - Fax:315-836-3782
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010600-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist