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General NPI Number Information
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NPI Number | 1356534739
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Entity Type | Individual
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Provider Name | LAURA LOVE HARRIS M.S., C.C.C.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 4500 I 55 N SUITE 291, HIGHLAND VILLAGE
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City | JACKSON
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State | MS
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Zip | 39211-5930
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Country | US
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Telephone | 601-362-0859
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Fax | 601-362-0870
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Provider Business Mailing Address
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Address Line | PO BOX 242
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City | RAYMOND
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State | MS
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Zip | 39154-0242
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Country | US
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Telephone | 601-857-0556
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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 | S2226
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License Number State | MS
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