Provider Demographics
NPI:1932127347
Name:HARRISON, KELLE ANN (MS)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 WHITE PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5112
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:914-241-1176
Practice Address - Street 1:21 READE PLACE, SUITE 3200
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4532
Practice Address - Country:US
Practice Address - Phone:845-471-4086
Practice Address - Fax:845-471-8296
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002046-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM75271Medicare PIN
NYQ54440Medicare UPIN