Provider Demographics
NPI:1821132101
Name:HARRIS, JANE C (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2903
Mailing Address - Country:US
Mailing Address - Phone:262-376-3890
Mailing Address - Fax:262-377-1899
Practice Address - Street 1:233 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2903
Practice Address - Country:US
Practice Address - Phone:262-376-3890
Practice Address - Fax:262-377-1899
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI052-2133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist