MEDICARE: MRS. PAULA MICHELLE HARRIS MSCCC/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	306-154	WI

General Provider Information

NPI Number	:	1295052017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA MICHELLE HARRIS MSCCC/SLP

Provider Business Mailing Address
First Line	:	2758 N AVONDALE BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1361
Country	:	US
Telephone Number	:	414-447-9205
Fax Number	:	414-447-9205

Provider Business Practice Location Address
First Line	:	2758 N AVONDALE BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1361
Country	:	US
Telephone Number	:	414-447-9205
Fax Number	:	414-447-9205

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

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/04/2010

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