Provider Demographics
NPI:1205496130
Name:PODLOGAR, STEPHANIE QUINN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:QUINN
Last Name:PODLOGAR
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 1:695 SOUTH ST
Mailing Address - Street 2:STE 6
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1474
Mailing Address - Country:US
Mailing Address - Phone:440-286-1553
Mailing Address - Fax:440-286-1318
Practice Address - Street 1:695 SOUTH ST
Practice Address - Street 2:STE 6
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1474
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:440-286-1318
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor