Provider Demographics
NPI:1720767213
Name:PONKO, CHIARA ELIZABETH (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:CHIARA
Middle Name:ELIZABETH
Last Name:PONKO
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412709
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2709
Mailing Address - Country:US
Mailing Address - Phone:410-760-8840
Mailing Address - Fax:
Practice Address - Street 1:205 CENTER ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5498
Practice Address - Country:US
Practice Address - Phone:410-760-8840
Practice Address - Fax:410-367-2464
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01666231H00000X, 237600000X
VA2201001921237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter