Provider Demographics
NPI:1447441316
Name:NOWAK, PHILOMENA BRIDGET (MS LCPC CRC)
Entity type:Individual
Prefix:MRS
First Name:PHILOMENA
Middle Name:BRIDGET
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MS LCPC CRC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:NOWAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LCPC CRC
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448
Mailing Address - Country:US
Mailing Address - Phone:708-479-8977
Mailing Address - Fax:708-479-8987
Practice Address - Street 1:9405 BORMET
Practice Address - Street 2:SUITE 10
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-479-8977
Practice Address - Fax:708-479-8987
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00005014225C00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor