Provider Demographics
NPI:1942532783
Name:PORTER, JANA D (MSP , CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:D
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSP , CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 LIME KILN RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8800
Mailing Address - Country:US
Mailing Address - Phone:803-535-0129
Mailing Address - Fax:
Practice Address - Street 1:296 LIME KILN RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8800
Practice Address - Country:US
Practice Address - Phone:803-535-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist