Provider Demographics
NPI:1730904665
Name:HARRIS, KATRINA J
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 N 190TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4685
Mailing Address - Country:US
Mailing Address - Phone:402-812-6676
Mailing Address - Fax:
Practice Address - Street 1:2019 CROWN FLAIR DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3331
Practice Address - Country:US
Practice Address - Phone:402-812-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities