Provider Demographics
NPI:1871731075
Name:PORTER, CHRISTINE L (MASPEECH PATHOLOGY)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:MASPEECH PATHOLOGY
Other - Prefix:
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Mailing Address - Street 1:7507 WOODBRIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4097
Mailing Address - Country:US
Mailing Address - Phone:602-909-8723
Mailing Address - Fax:269-350-5303
Practice Address - Street 1:7507 WOODBRIDGE LANE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4097
Practice Address - Country:US
Practice Address - Phone:602-909-8723
Practice Address - Fax:269-350-5303
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ01040307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist