MEDICARE: MIKELLE PORTER M.S, CF-SLP

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	390200000X	Student in an Organized Health Care Education/Training Program	203261	AR

General Provider Information

NPI Number	:	1962388488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKELLE PORTER M.S, CF-SLP

Provider Business Mailing Address
First Line	:	1604 BROADDRICK LN
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-8951
Country	:	US
Telephone Number	:	479-208-8689
Fax Number	:

Provider Business Practice Location Address
First Line	:	8411 S 28TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8646
Country	:	US
Telephone Number	:	479-648-9600
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ MIKELLE PORTER M.S, CF-SLP” Practice Location

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