Healthcare Provider Details

I. General information

NPI: 1285995688
Provider Name (Legal Business Name): MISS CATHERINE ANNE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 12/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SE DOUGLAS SUITE 205
LEE'S SUMMIT MO
64081
US

IV. Provider business mailing address

226 SE DOUGLAS SUITE 205
LEE'S SUMMIT MO
64081
US

V. Phone/Fax

Practice location:
  • Phone: 816-392-4561
  • Fax: 816-581-3738
Mailing address:
  • Phone: 816-392-4561
  • Fax: 816-581-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number0361231
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: