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General NPI Number Information
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NPI Number | 1871731075
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Entity Type | Individual
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Provider Name | CHRISTINE L. PORTER M.A.SPEECH PATHOLOGY
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Gender | Female
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 7507 WOODBRIDGE LANE
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City | PORTAGE
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State | MI
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Zip | 49024-4097
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Country | US
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Telephone | 602-909-8723
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Fax | 269-350-5303
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Provider Business Mailing Address
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Address Line | 7507 WOODBRIDGE LANE
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City | PORTAGE
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State | MI
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Zip | 49024-4097
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Country | US
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Telephone | 602-909-8723
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Fax | 269-350-5303
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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 | 01040307
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License Number State | AZ
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