Provider Demographics
NPI:1386054237
Name:HARRIS, CECELIA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:CECELIA
Other - Middle Name:
Other - Last Name:SPONSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11216 GERMANIA RD
Mailing Address - Street 2:
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103-4009
Mailing Address - Country:US
Mailing Address - Phone:417-664-0355
Mailing Address - Fax:
Practice Address - Street 1:11216 GERMANIA RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-4009
Practice Address - Country:US
Practice Address - Phone:417-664-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3463235Z00000X
MO2013024910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist