Provider Demographics
NPI:1386791812
Name:HARRIS, MICHAEL D (PHD CCC SLP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S THIRD ST
Mailing Address - Street 2:SPEECH AND HEARING CLINIC UW RIVER FALLS
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022
Mailing Address - Country:US
Mailing Address - Phone:715-425-3801
Mailing Address - Fax:715-425-3800
Practice Address - Street 1:410 S THIRD ST
Practice Address - Street 2:SPEECH AND HEARING CLINIC UW RIVER FALLS
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022
Practice Address - Country:US
Practice Address - Phone:715-425-3801
Practice Address - Fax:715-425-3800
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI553154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5G438HAOtherBCBS