Individual
STACEY KELEEN HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
33461 SE PEORIA RD, CORVALLIS, OR 97333-2521
(541) 704-4010
Mailing address
2963 NW FILLMORE AVE, CORVALLIS, OR 97330-5165
(406) 304-8330
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17834
OR
235Z00000X
Speech-Language Pathologist
MT-SLP-SP-LIC-9724
MT
235Z00000X
Speech-Language Pathologist
SLP-SP-LIC-9724
MT
Other
Enumeration date
05/11/2020
Last updated
05/17/2024
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