Provider Demographics
NPI:1992355804
Name:PORTER, ALISHA (SLP)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARDY COUNTY BOARD OF EDUCATION
Mailing Address - Street 2:510 ASHBY STREET
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26936
Mailing Address - Country:US
Mailing Address - Phone:304-267-3595
Mailing Address - Fax:304-267-3595
Practice Address - Street 1:HARDY COUNTY BOARD OF EDUCATION
Practice Address - Street 2:510 ASHBY STREET
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26936
Practice Address - Country:US
Practice Address - Phone:304-267-3595
Practice Address - Fax:304-267-3595
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSLP-1702OtherWV BOARD OF EXAMINERS CARD