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General NPI Number Information
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NPI Number | 1083350896
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Entity Type | Individual
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Provider Name | MR. MATTHEW HARRIS
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Gender | Male
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 101 ISAAC GREER CT
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City | BARDSTOWN
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State | KY
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Zip | 40004-2562
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Country | US
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Telephone | 502-349-6214
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Fax |
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Provider Business Mailing Address
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Address Line | 993 VINE ST
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City | LOUISVILLE
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State | KY
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Zip | 40204-2071
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | KY
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