Provider Demographics
NPI:1588536577
Name:ZODA, EMILY JOLYN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOLYN
Last Name:ZODA
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 1:7 PENDLETON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2111
Mailing Address - Country:US
Mailing Address - Phone:630-605-4745
Mailing Address - Fax:
Practice Address - Street 1:4050 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8183
Practice Address - Country:US
Practice Address - Phone:630-984-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician