Provider Demographics
NPI:1417382813
Name:NOVOTNY, SUSAN WYND
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WYND
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAYE
Other - Last Name:NOVOTNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. 1707
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-972-9040
Mailing Address - Fax:
Practice Address - Street 1:270 N PINE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4334
Practice Address - Country:US
Practice Address - Phone:707-972-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator