Healthcare Provider Details

I. General information

NPI: 1619071750
Provider Name (Legal Business Name): RICHARD WOOD HARRIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N 900 E 131 TLRB, BRIGHAM YOUNG UNIVERSITY
PROVO UT
84604-3536
US

IV. Provider business mailing address

1190 N 900 E 131 TLRB BRIGHAM YOUNG UNIVERSITY
PROVO UT
84602-8653
US

V. Phone/Fax

Practice location:
  • Phone: 801-422-6460
  • Fax: 801-422-0197
Mailing address:
  • Phone: 801-422-6460
  • Fax: 801-422-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number105321-4101
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: