Provider Demographics
NPI:1932663689
Name:HARRIS, LANCE (HIS)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RED CEDAR ST # 3
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2338
Mailing Address - Country:US
Mailing Address - Phone:715-235-3191
Mailing Address - Fax:715-832-5290
Practice Address - Street 1:392 RED CEDAR ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2338
Practice Address - Country:US
Practice Address - Phone:715-235-3191
Practice Address - Fax:715-832-5290
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1570-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist