Individual
CARLESE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5106 W STARK ST, MILWAUKEE, WI 53218-4314
(414) 558-6880
Mailing address
4371 SIRIUS AVE APT 9, LAS VEGAS, NV 89102-7668
(702) 809-0905
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/11/2011
Last updated
10/12/2020
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