Provider Demographics
NPI:1316415367
Name:NOVAK-CHON, VERA
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:NOVAK-CHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 RAINIER AVE S APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6954
Mailing Address - Country:US
Mailing Address - Phone:206-327-1303
Mailing Address - Fax:
Practice Address - Street 1:3401 RAINIER AVE S APT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6954
Practice Address - Country:US
Practice Address - Phone:206-327-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026117Medicaid