Provider Demographics
NPI:1013351600
Name:HARRIS, KATHRYN SUZANNE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUZANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 QUELINDA DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8270
Mailing Address - Country:US
Mailing Address - Phone:501-802-5400
Mailing Address - Fax:
Practice Address - Street 1:4609 QUELINDA DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8270
Practice Address - Country:US
Practice Address - Phone:501-802-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR79235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist