Provider Demographics
NPI:1629615273
Name:PORGES, JEANNE M
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:PORGES
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 1:1905 E KIOWA LN
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1839
Mailing Address - Country:US
Mailing Address - Phone:224-247-8193
Mailing Address - Fax:
Practice Address - Street 1:1905 E KIOWA LN
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1839
Practice Address - Country:US
Practice Address - Phone:224-247-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician