Provider Demographics
NPI:1063618064
Name:HARRIS, GINA KAY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5876 NIKE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8756
Mailing Address - Country:US
Mailing Address - Phone:614-921-1313
Mailing Address - Fax:
Practice Address - Street 1:44 S SOUDER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1539
Practice Address - Country:US
Practice Address - Phone:614-228-5900
Practice Address - Fax:614-228-3989
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist