Provider Demographics
NPI:1093297970
Name:PONOMARIOVA, ILONA
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:PONOMARIOVA
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 1:3313 LENOX VILLAGE DR UNIT 131
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4419
Mailing Address - Country:US
Mailing Address - Phone:330-623-5219
Mailing Address - Fax:
Practice Address - Street 1:3313 LENOX VILLAGE DR UNIT 131
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4419
Practice Address - Country:US
Practice Address - Phone:330-623-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health