Provider Demographics
NPI:1114168937
Name:PORTER, JAIME L (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:1921 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-8144
Mailing Address - Country:US
Mailing Address - Phone:217-762-5371
Mailing Address - Fax:217-762-4066
Practice Address - Street 1:1921 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-8144
Practice Address - Country:US
Practice Address - Phone:217-762-5371
Practice Address - Fax:217-762-4066
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010478104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker