Provider Demographics
NPI:1184837130
Name:PORT, TAMMY S (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:S
Last Name:PORT
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1509
Mailing Address - Country:US
Mailing Address - Phone:724-458-8454
Mailing Address - Fax:
Practice Address - Street 1:216 S CENTER ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1509
Practice Address - Country:US
Practice Address - Phone:724-458-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006157237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter