Provider Demographics
NPI:1386316370
Name:HARRIS, JEPHANIE DARLENE
Entity type:Individual
Prefix:
First Name:JEPHANIE
Middle Name:DARLENE
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 1:3025 URWILER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5719
Mailing Address - Country:US
Mailing Address - Phone:513-238-6837
Mailing Address - Fax:
Practice Address - Street 1:3025 URWILER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5719
Practice Address - Country:US
Practice Address - Phone:513-238-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services