Provider Demographics
NPI:1295627818
Name:HARRIS, BIANCA (BS, CLS)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16129 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1662
Mailing Address - Country:US
Mailing Address - Phone:708-846-0789
Mailing Address - Fax:
Practice Address - Street 1:16129 EVANS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1662
Practice Address - Country:US
Practice Address - Phone:708-846-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14586174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN