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NPI Code Detail

MEDICARE: ASHLEY PORTER

MEDICARE: ASHLEY 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
1101YP2500XProfessional Counselor178.015734IL

General Provider Information

NPI Number : 1811520786
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY PORTER
Provider Business Mailing Address
First Line : 1731 N MARCEY ST STE 510
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7955
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1731 N MARCEY ST STE 510
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7955
Country : US
Telephone Number : 312-618-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2020
Last Update Date : 02/19/2020

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Directions to “ ASHLEY PORTER ” Practice Location

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