Provider Demographics
NPI:1275356453
Name:HARRIS, MCKENZIE DEAN
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:DEAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 6TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7506
Mailing Address - Country:US
Mailing Address - Phone:559-225-2211
Mailing Address - Fax:
Practice Address - Street 1:5100 N 6TH ST STE 120
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7506
Practice Address - Country:US
Practice Address - Phone:559-225-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9053237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist