Individual
ELIZABETH ANNE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
1720 S AMPHLETT BLVD STE 110, SAN MATEO, CA 94402-2710
(650) 931-6300
Mailing address
2050 ASHRIDGE WAY, GRANITE BAY, CA 95746-7211
(916) 770-5585
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
28459
CA
Other
Enumeration date
04/17/2019
Last updated
04/17/2019
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