Individual
TREVOR KYLE HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
7610 PERSHING BLVD, KENOSHA, WI 53142-4318
(262) 948-3600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4545154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100185864
—
WI
Enumeration date
08/17/2021
Last updated
01/29/2025
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