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General NPI Number Information
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NPI Number | 1548072788
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Entity Type | Individual
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Provider Name | EMILY KATHRYN NOVAK PCSW
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Gender | Female
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 125 E PEARL AVE SUITE 108 PO BOX 2019
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-690-3180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 957
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City | WILSON
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State | WY
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Zip | 83014-0957
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Country | US
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Telephone | 917-254-2822
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PCSW-1210
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License Number State | WY
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