Provider Demographics
NPI:1083470181
Name:PORCO, KATHLEEN QUINN (MS, CDCES, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:QUINN
Last Name:PORCO
Suffix:
Gender:F
Credentials:MS, CDCES, NBC-HWC
Other - Prefix:
Other - First Name:KAT
Other - Middle Name:
Other - Last Name:PORCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NBC-HWC, CDCES
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-1176
Mailing Address - Country:US
Mailing Address - Phone:406-210-1143
Mailing Address - Fax:
Practice Address - Street 1:305 N PLATT AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9184
Practice Address - Country:US
Practice Address - Phone:406-210-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT972730872171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach