Provider Demographics
NPI:1629407747
Name:NOWICKI, JONATHAN (MA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7312
Mailing Address - Country:US
Mailing Address - Phone:559-647-0004
Mailing Address - Fax:
Practice Address - Street 1:584 E BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-2300
Practice Address - Country:US
Practice Address - Phone:559-365-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health