Provider Demographics
NPI:1629295654
Name:PORCELLA, NANCY (MA SPEECH PATH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:PORCELLA
Suffix:
Gender:F
Credentials:MA SPEECH PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746F S VICTORIA AVE # 356
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6592
Mailing Address - Country:US
Mailing Address - Phone:805-216-1166
Mailing Address - Fax:805-643-0114
Practice Address - Street 1:1746F S VICTORIA AVE # 356
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6592
Practice Address - Country:US
Practice Address - Phone:805-216-1166
Practice Address - Fax:805-643-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist