Provider Demographics
NPI:1497049886
Name:PORTER, SARA H (MA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:H
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3622
Mailing Address - Country:US
Mailing Address - Phone:315-732-0193
Mailing Address - Fax:
Practice Address - Street 1:2208 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3622
Practice Address - Country:US
Practice Address - Phone:315-732-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003200-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist