Provider Demographics
NPI:1447847223
Name:HARRIS, DEBORAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:318 MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1224
Mailing Address - Country:US
Mailing Address - Phone:908-403-9514
Mailing Address - Fax:
Practice Address - Street 1:318 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1224
Practice Address - Country:US
Practice Address - Phone:908-403-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2022-07-22
Deactivation Date:2021-03-17
Deactivation Code:
Reactivation Date:2022-07-22
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00381900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty