Provider Demographics
NPI:1265969554
Name:NOVAK, JORDAN BLITZ (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLITZ
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 70TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3672
Mailing Address - Country:US
Mailing Address - Phone:219-671-2956
Mailing Address - Fax:317-613-5898
Practice Address - Street 1:520 E 70TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3672
Practice Address - Country:US
Practice Address - Phone:219-671-2956
Practice Address - Fax:317-613-5898
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10163225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist