Provider Demographics
NPI:1588276273
Name:HARRIS, REBECA B
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:B
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 1:15429 52ND PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4308
Mailing Address - Country:US
Mailing Address - Phone:425-773-1483
Mailing Address - Fax:425-582-7701
Practice Address - Street 1:15429 52ND PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4308
Practice Address - Country:US
Practice Address - Phone:253-226-9185
Practice Address - Fax:425-582-7701
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC9229171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter