Healthcare Provider Details

I. General information

NPI: 1407262678
Provider Name (Legal Business Name): VIVIAN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 04/16/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 W GOOD HOPE RD APT 7
MILWAUKEE WI
53209-2362
US

IV. Provider business mailing address

3707 W GOOD HOPE RD APT 7
MILWAUKEE WI
53209-2362
US

V. Phone/Fax

Practice location:
  • Phone: 414-554-4994
  • Fax:
Mailing address:
  • Phone: 414-263-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: