Provider Demographics
NPI:1801209358
Name:PHARRIS, AUDREY ELIZABETH (MS CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:PHARRIS
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:ELIZABETH
Other - Last Name:EMBRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS SLP-A
Mailing Address - Street 1:8281 HWY 269
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320
Mailing Address - Country:US
Mailing Address - Phone:270-999-3533
Mailing Address - Fax:
Practice Address - Street 1:1595 US HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-9463
Practice Address - Country:US
Practice Address - Phone:270-274-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2013-093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist