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General NPI Number Information
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NPI Number | 1437521614
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Entity Type | Individual
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Provider Name | JAMES NORBY PORTER PHD, LP, ABPP-CN
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Gender | Male
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 4225 GOLDEN VALLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4215
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Country | US
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Telephone | 763-588-0661
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Fax | 763-302-4345
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Provider Business Mailing Address
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Address Line | 4225 GOLDEN VALLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4215
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Country | US
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Telephone | 763-588-0661
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Fax | 763-302-4345
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | LP5904
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP5904
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License Number State | MN
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