Provider Demographics
NPI:1467124024
Name:PORTER, DOLLE DEANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DOLLE
Middle Name:DEANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5017
Mailing Address - Country:US
Mailing Address - Phone:432-770-2147
Mailing Address - Fax:
Practice Address - Street 1:615 W MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5017
Practice Address - Country:US
Practice Address - Phone:432-770-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist