Provider Demographics
NPI:1447485230
Name:PORTER, BRIDGET LEIGH (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:LEIGH
Last Name:PORTER
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 HIGHWAY 4 E
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-2112
Mailing Address - Country:US
Mailing Address - Phone:662-252-1141
Mailing Address - Fax:
Practice Address - Street 1:1315 HIGHWAY 4 E
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-2112
Practice Address - Country:US
Practice Address - Phone:662-252-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist