Provider Demographics
NPI:1356359939
Name:HARRIS, PAULA K (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E SUNSET RD
Mailing Address - Street 2:UNIT 96595
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-1101
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:1000 FACTORY OUTLET BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-4179
Practice Address - Country:US
Practice Address - Phone:618-937-6419
Practice Address - Fax:618-932-3163
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001158231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881Medicare Oscar/Certification
IL205790Medicare PIN
ILR02854Medicare PIN