Provider Demographics
NPI:1023257136
Name:NOVAK, KERRY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KAKULE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 WESTFALL AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7268
Mailing Address - Country:US
Mailing Address - Phone:518-283-4483
Mailing Address - Fax:518-283-1973
Practice Address - Street 1:14 WESTFALL AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7268
Practice Address - Country:US
Practice Address - Phone:518-283-4483
Practice Address - Fax:518-283-1973
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012833-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist