Healthcare Provider Details

I. General information

NPI: 1568684728
Provider Name (Legal Business Name): WENDY T HARRIS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

1061 CULMER DR
VIRGINIA BEACH VA
23454-6721
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7000
  • Fax:
Mailing address:
  • Phone: 757-721-9403
  • Fax: 757-430-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002138
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: