Provider Demographics
NPI:1609994896
Name:JAGODZINSKI, EMILY ROSE
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:JAGODZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16424 N 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9340
Mailing Address - Country:US
Mailing Address - Phone:623-399-6585
Mailing Address - Fax:
Practice Address - Street 1:16424 N 113TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9340
Practice Address - Country:US
Practice Address - Phone:623-399-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3508175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath