Provider Demographics
NPI:1205869328
Name:HARRIS, CHERALYN DEANNE (MS, CCC-A)
Entity type:Individual
Prefix:MS
First Name:CHERALYN
Middle Name:DEANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 PINE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-9138
Mailing Address - Country:US
Mailing Address - Phone:601-683-3086
Mailing Address - Fax:
Practice Address - Street 1:928 PINE BLUFF RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-9138
Practice Address - Country:US
Practice Address - Phone:601-683-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA1079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770234Medicaid
MS00770234Medicaid