Provider Demographics
NPI:1952685745
Name:HARRIS, KERRY ANN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SKYLARK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-4108
Mailing Address - Country:US
Mailing Address - Phone:845-386-3764
Mailing Address - Fax:
Practice Address - Street 1:53 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6414
Practice Address - Country:US
Practice Address - Phone:845-326-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist