Provider Demographics
NPI:1821584053
Name:HARRIS, KELSEY (AUD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 BRUCE B DOWNS BLVD APT 3506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1347
Mailing Address - Country:US
Mailing Address - Phone:813-758-8093
Mailing Address - Fax:
Practice Address - Street 1:14020 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5778
Practice Address - Country:US
Practice Address - Phone:813-972-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2186231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist