| Irina Podolsky Psyd Llc | |
|
1623 W Main St Fairfield IL 62837-2343 | |
| (312) 320-5137 | |
| Not Available |
| Full Name | Irina Podolsky Psyd Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1623 W Main St, Fairfield, Illinois |
| Authorized Official Name and Position | Irina Podolsky (OWNER) |
| Authorized Official Contact | 3123205137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Irina Podolsky Psyd Llc Po Box 278 Fairfield IL 62837-0278 Ph: () - | Irina Podolsky Psyd Llc 1623 W Main St Fairfield IL 62837-2343 Ph: (312) 320-5137 |
| NPI Number | 1962916015 |
|---|---|
| Provider Enumeration Date | 11/28/2017 |
| Last Update Date | 11/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962916015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 073.000074 (Illinois) | Primary |
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