Provider Demographics
NPI:1598154916
Name:PORTZ, SHEILA M (HAS)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:M
Last Name:PORTZ
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 DERR RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2445
Mailing Address - Country:US
Mailing Address - Phone:937-408-4449
Mailing Address - Fax:
Practice Address - Street 1:423 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1820
Practice Address - Country:US
Practice Address - Phone:937-834-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3242237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1598154916OtherFEDERAL RETIREMENT PROGRAM BLUE CROSS /BLUE SHIELD