Provider Demographics
NPI:1417347592
Name:PORTERA, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:PORTERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N LAKEVIEW AVE
Mailing Address - Street 2:S3-04
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 N LAKEVIEW AVE
Practice Address - Street 2:S3-04
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2045
Practice Address - Country:US
Practice Address - Phone:312-560-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist