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General NPI Number Information
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NPI Number | 1447441316
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Entity Type | Individual
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Provider Name | PHILOMENA BRIDGET NOWAK MS LCPC CRC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 9405 BORMET SUITE 10
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-479-8977
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Fax | 708-479-8987
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-479-8977
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Fax | 708-479-8987
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00005014
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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