Provider Demographics
NPI:1295577401
Name:NOVOTNEY, CECILIA GRACE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:GRACE
Last Name:NOVOTNEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NW ROWAN ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8959
Mailing Address - Country:US
Mailing Address - Phone:641-512-1542
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist