Provider Demographics
NPI:1134756018
Name:HARRIS, MICHELLE R (HIS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CLIFFORD RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2110
Mailing Address - Country:US
Mailing Address - Phone:781-934-2928
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT ST STE 25
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5315
Practice Address - Country:US
Practice Address - Phone:781-934-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA333237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter