Provider Demographics
NPI:1043541485
Name:PORTER, RACHEL KIMBERLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:KIMBERLY
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14499 W WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4241
Mailing Address - Country:US
Mailing Address - Phone:623-975-2842
Mailing Address - Fax:
Practice Address - Street 1:14499 W WENDOVER DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4241
Practice Address - Country:US
Practice Address - Phone:623-975-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist