Provider Demographics
NPI:1780937052
Name:PORTER, HEATHER C (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:PORTER
Suffix:
Gender:
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:V
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1495
Mailing Address - Country:US
Mailing Address - Phone:815-899-8100
Mailing Address - Fax:
Practice Address - Street 1:820 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3270
Practice Address - Country:US
Practice Address - Phone:815-899-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist