MEDICARE: ERICA PORTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101009099	MI

General Provider Information

NPI Number	:	1780133967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA PORTER

Provider Business Mailing Address
First Line	:	504 MAIN ST STE E&G
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-3115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 MAIN ST STE E&G
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-3115
Country	:	US
Telephone Number	:	734-325-9305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	12/10/2025

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Directions to “ ERICA PORTER ” Practice Location

Language	Start Address	Practice Location

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