Provider Demographics
NPI:1114481116
Name:PORTER, HOLLIE DUDROW (MS-CCC SLP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:DUDROW
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS-CCC SLP
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:NICOLE
Other - Last Name:DUDROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3008 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4941
Mailing Address - Country:US
Mailing Address - Phone:301-514-4051
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6123
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid