Provider Demographics
NPI:1952379380
Name:HARRIS, DAVE ANDREW (PHD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:ANDREW
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SOUTH SPRING AVENUE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-8884
Mailing Address - Fax:
Practice Address - Street 1:3660 VISTA
Practice Address - Street 2:STE 312
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-977-5110
Practice Address - Fax:314-268-5111
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12006502231H00000X
MO2005034032237600000X
MO2003019973231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter