Provider Demographics
NPI:1336225788
Name:PORCHE, JOAN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:G
Last Name:PORCHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18154 HARWOOD
Mailing Address - Street 2:CARY BUILDING SUITE 108
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-508-1777
Mailing Address - Fax:708-481-8447
Practice Address - Street 1:18154 HARWOOD
Practice Address - Street 2:CARY BUILDING SUITE 108
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-508-1777
Practice Address - Fax:708-481-8447
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL149011281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
210241Medicare ID - Type Unspecified