Provider Demographics
NPI:1558785501
Name:NOVAK, TRANETTE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TRANETTE
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5906 BOGART RD W
Practice Address - Street 2:
Practice Address - City:CASTALIA
Practice Address - State:OH
Practice Address - Zip Code:44824-9714
Practice Address - Country:US
Practice Address - Phone:419-684-5357
Practice Address - Fax:419-684-6049
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist