Basic Information
| Provider Information | |||||||||
| NPI: | 1952379380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | DAVE | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 SOUTH SPRING AVENUE | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149778884 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3660 VISTA | ||||||||
| Address2: | STE 312 | ||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149775110 | ||||||||
| FaxNumber: | 3142685111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 12006502 | MO | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 2005034032 | MO | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 2003019973 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.