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General NPI Number Information
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NPI Number | 1417526641
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Entity Type | Individual
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Provider Name | TANYA MARIE NOVOTNAK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 4785 HAYES RD STE 100
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City | MADISON
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State | WI
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Zip | 53704-7364
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Country | US
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Telephone | 608-242-7160
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Fax |
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Provider Business Mailing Address
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Address Line | 4785 HAYES RD STE 100
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City | MADISON
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State | WI
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Zip | 53704-7364
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Country | US
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Telephone | 608-242-7160
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5192
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 857723
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License Number State | WI
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