Provider Demographics
NPI:1134217110
Name:HARRIS, GINGER W (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:W
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:GINGER
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SLP CCC
Mailing Address - Street 1:300 STONECREST DRIVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-220-5796
Mailing Address - Fax:615-220-8829
Practice Address - Street 1:300 STONECREST DRIVE
Practice Address - Street 2:SUITE 375
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:615-220-8829
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist