MEDICARE: JENNA V HARRIS MS, CF-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	9315	LA

General Provider Information

NPI Number	:	1013696087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA V HARRIS MS, CF-SLP

Provider Business Mailing Address
First Line	:	106 FALLOW LN
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-5323
Country	:	US
Telephone Number	:	985-519-7497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 S BURNSIDE AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-4642
Country	:	US
Telephone Number	:	225-269-9971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	04/07/2026

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