Provider Demographics
NPI:1770639932
Name:HARRIS, DONALD R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MCGONAGLE RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9421
Mailing Address - Country:US
Mailing Address - Phone:509-833-3264
Mailing Address - Fax:509-925-4433
Practice Address - Street 1:508 N RUBY ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3154
Practice Address - Country:US
Practice Address - Phone:509-833-3264
Practice Address - Fax:509-925-4433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist