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General NPI Number Information
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NPI Number | 1174989073
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Entity Type | Individual
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Provider Name | SARAH NOVAK CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1740 SYCAMORE AVE SUITE A
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City | KINGMAN
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State | AZ
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Zip | 86409-0927
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Country | US
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Telephone | 928-681-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 WITTINGTON PL 175
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City | DALLAS
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State | TX
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Zip | 75234-1927
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | LL60586665
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 111721
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 74912
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP9546
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License Number State | AZ
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