Provider Demographics
NPI:1013698083
Name:MANEICE, PORSCHE (SLP)
Entity Type:Individual
Prefix:
First Name:PORSCHE
Middle Name:
Last Name:MANEICE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 S STATE ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2824
Mailing Address - Country:US
Mailing Address - Phone:205-260-8878
Mailing Address - Fax:
Practice Address - Street 1:242 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2514
Practice Address - Country:US
Practice Address - Phone:253-627-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61458218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist