Provider Demographics
NPI:1922164912
Name:HARRISON, STEPHEN C (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:HARRISON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 BLAIRS FERRY RD NE
Mailing Address - Street 2:STE 110
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-378-8077
Mailing Address - Fax:319-393-0895
Practice Address - Street 1:921 BLAIRS FERRY RD NE
Practice Address - Street 2:STE 110
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-378-8077
Practice Address - Fax:319-393-0895
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00765237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0446724Medicaid