Provider Demographics
NPI:1952809980
Name:HARRIS, ANNA THERESE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:THERESE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:MAICHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:266 CRESCENT ST # 1
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3417
Mailing Address - Country:US
Mailing Address - Phone:508-404-5217
Mailing Address - Fax:
Practice Address - Street 1:266 CRESCENT ST # 1
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3417
Practice Address - Country:US
Practice Address - Phone:508-404-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist