Provider Demographics
NPI:1598515025
Name:29:11 HEALING HARBOR, PLLC
Entity Type:Organization
Organization Name:29:11 HEALING HARBOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:630-708-0392
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:SOMONAUK
Mailing Address - State:IL
Mailing Address - Zip Code:60552-0224
Mailing Address - Country:US
Mailing Address - Phone:630-708-0392
Mailing Address - Fax:
Practice Address - Street 1:450 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:SOMONAUK
Practice Address - State:IL
Practice Address - Zip Code:60552-3230
Practice Address - Country:US
Practice Address - Phone:630-708-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty