Healthcare Provider Details

I. General information

NPI: 1366563868
Provider Name (Legal Business Name): KAMMI PORCELLO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HEALTH SYSTEM K-8 AUDIOLOGY
DETROIT MI
48202-2608
US

IV. Provider business mailing address

22111 VIOLET ST
SAINT CLAIR SHORES MI
48082-1982
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-1089
  • Fax:
Mailing address:
  • Phone: 586-899-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000106
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: