Provider Demographics
NPI:1851964662
Name:PORTER, CAROL SUE (BS, MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:PORTER
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31970 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43983-9718
Mailing Address - Country:US
Mailing Address - Phone:740-439-5634
Mailing Address - Fax:
Practice Address - Street 1:1300 CLAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-1614
Practice Address - Country:US
Practice Address - Phone:740-439-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator