Provider Demographics
NPI:1326268095
Name:NOWAKOWSKI, JENNIFER KAY (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4642
Mailing Address - Country:US
Mailing Address - Phone:630-540-2173
Mailing Address - Fax:630-540-2173
Practice Address - Street 1:845 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4642
Practice Address - Country:US
Practice Address - Phone:630-540-2173
Practice Address - Fax:630-540-2173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist