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General NPI Number Information
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NPI Number | 1093298259
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Entity Type | Individual
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Provider Name | RAQUEL NOWAK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 9631 W 153RD ST STE 38
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City | ORLAND PARK
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State | IL
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Zip | 60462-3778
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Country | US
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Telephone | 773-888-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 5659 S KOLIN AVE
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City | CHICAGO
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State | IL
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Zip | 60629-4838
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Country | US
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Telephone | 773-888-2586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.009820
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License Number State | IL
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