Doctor Name: | MRS. ELIZABETH RENEE PORTER |
NPI Number: | 1114108156 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2002014290 |
Business Practice Address: | Eldon R-i 112 S Pine St Eldon, MO - 650261581 |
Business Phone Number: | 5733928003 |
Business Fax Number: | 5733928080 |
Mailing Address: | 112 S Pine St, ELDON |
State: | MO |
Postal Code: | 650261581 |
Phone Number: | 5733928003 |
Fax Number: | 5733928080 |
NPI Enumeration Date: | 11/19/2007 |
NPI Last Update Date: | 02/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2002014290 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |