Provider Demographics
NPI:1841046109
Name:HARRIS, TONI (CRT/CHC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CRT/CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2631
Mailing Address - Country:US
Mailing Address - Phone:319-230-9224
Mailing Address - Fax:
Practice Address - Street 1:1618 W 11TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2631
Practice Address - Country:US
Practice Address - Phone:319-230-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach