Provider Demographics
NPI:1780713446
Name:POLODNA, ANN M (LCPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:POLODNA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16033 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5989
Mailing Address - Country:US
Mailing Address - Phone:708-602-2103
Mailing Address - Fax:708-349-9199
Practice Address - Street 1:16033 91ST AVE
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60477-5989
Practice Address - Country:US
Practice Address - Phone:708-602-2103
Practice Address - Fax:708-349-9199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional