Provider Demographics
NPI:1437598836
Name:PORISCH, PAMELA JO
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:PORISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8724
Mailing Address - Country:US
Mailing Address - Phone:701-237-9977
Mailing Address - Fax:952-392-1001
Practice Address - Street 1:825 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8724
Practice Address - Country:US
Practice Address - Phone:701-237-9977
Practice Address - Fax:952-392-1001
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2735237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist