Provider Demographics
NPI:1215248398
Name:PORTER, AMY LEIGH
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:PORTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43225 BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-6300
Mailing Address - Country:US
Mailing Address - Phone:503-949-0137
Mailing Address - Fax:
Practice Address - Street 1:225 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428-8503
Practice Address - Country:US
Practice Address - Phone:503-949-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099316811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical