Provider Demographics
NPI:1902540412
Name:JOHNSON, PORSCHE NICOLE
Entity type:Individual
Prefix:
First Name:PORSCHE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PORSCHE
Other - Middle Name:NICOLE
Other - Last Name:BLUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2812 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6202
Mailing Address - Country:US
Mailing Address - Phone:620-208-7878
Mailing Address - Fax:620-208-7000
Practice Address - Street 1:101 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2906
Practice Address - Country:US
Practice Address - Phone:785-762-3350
Practice Address - Fax:785-762-3920
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist