Healthcare Provider Details

I. General information

NPI: 1326954926
Provider Name (Legal Business Name): NIMA NOVAK MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 PATTY LN
MIDDLETON WI
53562-1651
US

IV. Provider business mailing address

3116 PATTY LN
MIDDLETON WI
53562-1651
US

V. Phone/Fax

Practice location:
  • Phone: 323-454-3224
  • Fax:
Mailing address:
  • Phone: 323-454-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: