Provider Demographics
NPI:1467909184
Name:PORTER, DONNA SUSANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SUSANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:SUSANNE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6224 PINEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7704
Mailing Address - Country:US
Mailing Address - Phone:614-850-8217
Mailing Address - Fax:
Practice Address - Street 1:6224 PINEFIELD DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7704
Practice Address - Country:US
Practice Address - Phone:614-850-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 3279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist