Provider Demographics
NPI:1952025355
Name:PODLASKI, KATHERINE PAIGE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PAIGE
Last Name:PODLASKI
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 1:509 HEDGE ROW CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7715
Mailing Address - Country:US
Mailing Address - Phone:724-996-7592
Mailing Address - Fax:
Practice Address - Street 1:509 HEDGE ROW CT
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7715
Practice Address - Country:US
Practice Address - Phone:724-996-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program