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General NPI Number Information
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NPI Number | 1184105207
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Entity Type | Individual
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Provider Name | ELIZABETH ANN NOVAK CT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 12/14/2019
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Provider Practice Location Address
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Address Line | 4637 N ASHLAND AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60640-4630
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Country | US
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Telephone | 630-270-9845
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 N KEDZIE BLVD # 1
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City | CHICAGO
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State | IL
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Zip | 60647-2632
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Country | US
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Telephone | 630-270-9845
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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 | 242004813
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License Number State | IL
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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 | 146015092
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License Number State | IL
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