Provider Demographics
NPI:1982097788
Name:PODOLL, TROY (HAD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:PODOLL
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12367 390TH AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1315 6TH AVE SE
Practice Address - Street 2:SUITE 4
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4900
Practice Address - Country:US
Practice Address - Phone:605-229-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD397H235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist