Healthcare Provider Details

I. General information

NPI: 1730098963
Provider Name (Legal Business Name): MARYMARGARET GRACE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E BRADFORD PKWY STE 210-4
SPRINGFIELD MO
65804-6539
US

IV. Provider business mailing address

1531 E BRADFORD PKWY STE 210-4
SPRINGFIELD MO
65804-6539
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-9500
  • Fax:
Mailing address:
  • Phone: 417-881-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: