Provider Demographics
NPI:1760181382
Name:HARRIS, LETRICE (TRICHOLOGY)
Entity Type:Individual
Prefix:
First Name:LETRICE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:TRICHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 183RD ST STE 181
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3933
Mailing Address - Country:US
Mailing Address - Phone:773-710-8893
Mailing Address - Fax:
Practice Address - Street 1:6851 167TH ST STE 5
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2501
Practice Address - Country:US
Practice Address - Phone:773-710-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier