Active NPI
Susan Porcaro, M.A., CCC-SLP
- Speech-Language Pathologist
- Medford, OR
National Provider Identifier
1801932637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 11302
- Practice address
- 608 Franquette St
Medford, OR 97501-7832 - Phone
- (541) 858-1793
- Fax
- (541) 858-1793
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 11302 | OR | Primary |
Addresses
Primary practice location
608 Franquette St
Medford, OR 97501-7832
Mailing address
PO Box 1345
Rogue River, OR 97537-1345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240357 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11302 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801932637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1345",
"city": "ROGUE RIVER",
"state": "OR",
"postal_code": "975371345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 FRANQUETTE ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975017832",
"telephone_number": "541-858-1793",
"fax_number": "541-858-1793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORCARO",
"first_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "11302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240357",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.