Provider Demographics
NPI:1730116542
Name:HARRIS, LYNN V (AUD CCC SPA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:V
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AUD CCC SPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S RESERVE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4755
Mailing Address - Country:US
Mailing Address - Phone:406-926-1969
Mailing Address - Fax:406-926-1970
Practice Address - Street 1:1515 S RESERVE ST STE 110
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4755
Practice Address - Country:US
Practice Address - Phone:406-926-1969
Practice Address - Fax:406-926-1970
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT135237600000X
MT432231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0530995Medicaid
M000002756Medicare PIN