Provider Demographics
NPI:1144570060
Name:PORTER, CHRISTINE LYNNE (MSW, LAPSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSW, LAPSW
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:LYNNE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3220 W VLIET ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2453
Mailing Address - Country:US
Mailing Address - Phone:414-231-4000
Mailing Address - Fax:414-231-4016
Practice Address - Street 1:3220 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2453
Practice Address - Country:US
Practice Address - Phone:414-231-4000
Practice Address - Fax:414-231-4016
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126469-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI126469-121OtherSOCIAL WORK LICENSE NUMBER