Provider Demographics
NPI:1205122751
Name:HARRIS, SHANNON LEIGH (CCC-SP NYSLSP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEIGH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CCC-SP NYSLSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1402
Mailing Address - Country:US
Mailing Address - Phone:518-489-0607
Mailing Address - Fax:
Practice Address - Street 1:194 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1402
Practice Address - Country:US
Practice Address - Phone:518-827-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011686-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist