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General NPI Number Information
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NPI Number | 1295696615
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Entity Type | Organization
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Legal Business Name | PORTER WELLNESS INC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 3209 INGERSOLL AVE STE 100
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City | DES MOINES
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State | IA
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Zip | 50312-3920
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Country | US
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Telephone | 515-318-7062
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Fax | 515-318-7062
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Provider Business Mailing Address
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Address Line | 1734 63RD ST
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50324-5950
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Country | US
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Telephone | 515-318-7062
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Fax | 515-318-7062
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOGAN LUNNING PORTER
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Credential | LISW
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Telephone | 515-661-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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