Doctor Name: | MICHELE LYNN NOWAK |
NPI Number: | 1073958260 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.007320 |
Business Practice Address: | 7000 W 111th St Worth, IL - 604821851 |
Business Phone Number: | 7082993070 |
Business Fax Number: | |
Mailing Address: | 6258 107th St, CHICAGO RIDGE |
State: | IL |
Postal Code: | 604152170 |
Phone Number: | 7082993070 |
Fax Number: | |
NPI Enumeration Date: | 05/01/2013 |
NPI Last Update Date: | 05/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.007320 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |