MEDICARE: MRS. JULIE ANNE HARRIS

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	146.009887	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518355072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANNE HARRIS

Provider Business Mailing Address
First Line	:	3343 N LEAVITT ST
Second Line	:	UNIT #2
City	:	CHICAGO
State	:	IL
Zip	:	60618-6242
Country	:	US
Telephone Number	:	847-338-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	3343 N LEAVITT ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6242
Country	:	US
Telephone Number	:	847-338-0972
Fax Number	:

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

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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