Provider Demographics
NPI:1093298259
Name:NOWAK, RAQUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 S KOLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4838
Mailing Address - Country:US
Mailing Address - Phone:773-888-2586
Mailing Address - Fax:
Practice Address - Street 1:9631 W 153RD ST STE 38
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3778
Practice Address - Country:US
Practice Address - Phone:773-888-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist