Provider Demographics
NPI:1447538293
Name:HARRIS, SANDRA WRAPP (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:WRAPP
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5663
Mailing Address - Country:US
Mailing Address - Phone:404-304-9251
Mailing Address - Fax:
Practice Address - Street 1:3607 SIERRA DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5663
Practice Address - Country:US
Practice Address - Phone:404-304-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist