Provider Demographics
NPI:1992052484
Name:HARRIS, BRENDA FRANCES (SLP-L)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:FRANCES
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18656 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3729
Mailing Address - Country:US
Mailing Address - Phone:708-323-7057
Mailing Address - Fax:
Practice Address - Street 1:1807 222ND PL
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5047
Practice Address - Country:US
Practice Address - Phone:708-757-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146-005954OtherIL STATE LICENSE, SPEECH PATHOLOGY