Provider Demographics
NPI:1881860286
Name:HARRIS, NANCY AMALIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:AMALIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 TARRANT TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3623
Mailing Address - Country:US
Mailing Address - Phone:336-462-7911
Mailing Address - Fax:
Practice Address - Street 1:4505 SHATTALON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2001
Practice Address - Country:US
Practice Address - Phone:336-924-9309
Practice Address - Fax:336-924-0388
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist