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NPI Code Detail

MEDICARE: JESSICA MARIE PODGORSKI

MEDICARE: JESSICA MARIE PODGORSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianP32643397962IL

General Provider Information

NPI Number : 1598421471
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE PODGORSKI
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 8505 183RD ST STE D
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-3706
Country : US
Telephone Number : 708-864-2990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2021
Last Update Date : 11/15/2021

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Directions to “ JESSICA MARIE PODGORSKI ” Practice Location

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