Basic Information
| Provider Information | |||||||||
| NPI: | 1518481126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | HAITHCOCK | ||||||||
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| Credential: | M. ED., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 BISCOE RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273719308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109751999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 DOWD CIR STE A | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283747932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102952609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 3105 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.