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General NPI Number Information
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NPI Number | 1083937205
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Entity Type | Individual
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Provider Name | AMY ELIZABETH PORTER WAREHAM MA CCC - SLP
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 2 TYLER POINT RD
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City | BARRINGTON
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State | RI
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Zip | 02806-4431
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Country | US
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Telephone | 617-620-2661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 227
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City | BARRINGTON
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State | RI
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Zip | 02806-0227
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Country | US
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Telephone | 617-620-2661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP00873
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6289
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License Number State | MA
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