Provider Demographics
NPI:1457904377
Name:PORT, ALAN W II (MSW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:W
Last Name:PORT
Suffix:II
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 W RICHLAND RD LOT 74
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-8686
Mailing Address - Country:US
Mailing Address - Phone:575-439-7241
Mailing Address - Fax:
Practice Address - Street 1:222 W MISSION AVE STE 122
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2345
Practice Address - Country:US
Practice Address - Phone:509-842-0067
Practice Address - Fax:509-314-8945
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609756771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical