Provider Demographics
NPI:1881031870
Name:NEESSEN, PORTER JEAN (MA)
Entity Type:Individual
Prefix:
First Name:PORTER
Middle Name:JEAN
Last Name:NEESSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LOUISIANA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2856
Mailing Address - Country:US
Mailing Address - Phone:361-853-0488
Mailing Address - Fax:
Practice Address - Street 1:1001 LOUISIANA AVE STE 402
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2856
Practice Address - Country:US
Practice Address - Phone:361-853-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist