Provider Demographics
NPI:1427940998
Name:HARRIS, MICHELLE ALICIA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALICIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ALICIA
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 N 1000 E
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1500
Mailing Address - Country:US
Mailing Address - Phone:435-213-6654
Mailing Address - Fax:
Practice Address - Street 1:3006 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1530
Practice Address - Country:US
Practice Address - Phone:435-213-6654
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
UT374J00000X
UT5852003-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula