Provider Demographics
NPI:1083929178
Name:PODGORSKI, STACEY M (MED, CDMS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:PODGORSKI
Suffix:
Gender:F
Credentials:MED, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8256 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9100
Mailing Address - Country:US
Mailing Address - Phone:859-795-0766
Mailing Address - Fax:859-282-9918
Practice Address - Street 1:8256 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9100
Practice Address - Country:US
Practice Address - Phone:859-795-0766
Practice Address - Fax:859-282-9918
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator