Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | IL |
NPI | 1003386202 |
---|---|
Provider Name | Keli Novack |
First Address | Northbrook, IL 60062-8005 |
Second Address | Northbrook, IL 60062-8005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 29/11/2018 |