Provider Demographics
NPI:1265616791
Name:NOVACK, MONIKA MARIE (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:MARIE
Last Name:NOVACK
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:MARIE
Other - Last Name:CARINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1841
Mailing Address - Country:US
Mailing Address - Phone:716-816-4040
Mailing Address - Fax:
Practice Address - Street 1:225 LAWN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1841
Practice Address - Country:US
Practice Address - Phone:716-816-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017775-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist