Provider Demographics
NPI:1093858821
Name:PORTER, BETHANY HARRIS (AUD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:HARRIS
Last Name:PORTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1456
Mailing Address - Country:US
Mailing Address - Phone:304-766-6555
Mailing Address - Fax:304-768-2335
Practice Address - Street 1:416 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1456
Practice Address - Country:US
Practice Address - Phone:304-766-6555
Practice Address - Fax:304-768-2335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0245231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist