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General NPI Number Information
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NPI Number | 1306247747
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Entity Type | Individual
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Provider Name | SARAH EMMA PORTER PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 6510 GRAND TETON PLZ STE 102 SUITE 24
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-556-9110
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Fax | 608-204-0094
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Provider Business Mailing Address
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Address Line | 6510 GRAND TETON PLAZA SUITE 102
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City | MADISON
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State | WI
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Zip | 53719-1031
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Country | US
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Telephone | 608-841-1606
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Fax | 608-492-2573
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 319857
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License Number State | WI
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