Provider Demographics
NPI:1528220530
Name:PORPS, SANDRA L (AUD CCC-A)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:PORPS
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:PORPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD CCC-A
Mailing Address - Street 1:10271 E AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-2600
Mailing Address - Country:US
Mailing Address - Phone:734-483-2005
Mailing Address - Fax:
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-657-4173
Practice Address - Fax:248-865-6161
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist