MEDICARE: JENNIFER NOVAK MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1477119402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NOVAK MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1475 MAPLE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-5418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 N BISSELL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5506
Country	:	US
Telephone Number	:	773-870-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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Directions to “ JENNIFER NOVAK MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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