Provider Demographics
NPI:1760795512
Name:PORCARO, DAWNELL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWNELL
Middle Name:
Last Name:PORCARO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BRASELTON HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5907
Mailing Address - Country:US
Mailing Address - Phone:678-377-9634
Mailing Address - Fax:678-377-9634
Practice Address - Street 1:1020 BARBER CREEK DR STE 113
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5980
Practice Address - Country:US
Practice Address - Phone:706-583-9525
Practice Address - Fax:706-583-9526
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist