Provider Demographics
NPI:1306247747
Name:PORTER, SARAH EMMA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:EMMA
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6510 GRAND TETON PLAZA SUITE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1031
Mailing Address - Country:US
Mailing Address - Phone:608-841-1606
Mailing Address - Fax:608-492-2573
Practice Address - Street 1:6510 GRAND TETON PLZ STE 102
Practice Address - Street 2:SUITE 24
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-556-9110
Practice Address - Fax:608-204-0094
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical