Healthcare Provider Details

I. General information

NPI: 1780133967
Provider Name (Legal Business Name): ERICA PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MAIN ST STE E&G
BELLEVILLE MI
48111-3115
US

IV. Provider business mailing address

504 MAIN ST STE E&G
BELLEVILLE MI
48111-3115
US

V. Phone/Fax

Practice location:
  • Phone: 734-325-9305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: