Provider Demographics
NPI:1194546879
Name:PODGORNY, EMILY KATHRYN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:PODGORNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11041 FRONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1580
Mailing Address - Country:US
Mailing Address - Phone:708-995-7256
Mailing Address - Fax:
Practice Address - Street 1:11041 FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1580
Practice Address - Country:US
Practice Address - Phone:708-995-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.002022237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter