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General NPI Number Information
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NPI Number | 1447778865
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Entity Type | Organization
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Legal Business Name | PORTER SPEECH PATHOLOGY LLC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 4531 STATE ROUTE 54
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City | OWENSBORO
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State | KY
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Zip | 42303-2486
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Country | US
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Telephone | 270-240-3089
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 CARTER RD
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City | WHITESVILLE
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State | KY
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Zip | 42378-9427
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Country | US
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Telephone | 270-313-2572
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY PORTER
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Credential | MS CCC-SLP
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Telephone | 270-313-2572
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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 | 140396
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License Number State | KY
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