Provider Demographics
NPI:1184105207
Name:NOVAK, ELIZABETH ANN (CT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2411 N KEDZIE BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2632
Mailing Address - Country:US
Mailing Address - Phone:630-270-9845
Mailing Address - Fax:
Practice Address - Street 1:4637 N ASHLAND AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4630
Practice Address - Country:US
Practice Address - Phone:630-270-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004813235Z00000X
IL146015092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty