Provider Demographics
NPI:1578374211
Name:HARRIS, DAWN FAIRLEY (PHD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:FAIRLEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:DANEEN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4501 CASTLE PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7438
Mailing Address - Country:US
Mailing Address - Phone:928-366-3271
Mailing Address - Fax:
Practice Address - Street 1:4501 CASTLE PINES DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7438
Practice Address - Country:US
Practice Address - Phone:928-533-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP15843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist