Provider Demographics
NPI:1124330568
Name:HARRIS, KATHRYN JILL (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JILL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 S LYNHURST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8630
Mailing Address - Country:US
Mailing Address - Phone:317-919-5140
Mailing Address - Fax:
Practice Address - Street 1:2345 S LYNHURST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8630
Practice Address - Country:US
Practice Address - Phone:317-919-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool