MARY NOWACK (NPI# 1831318203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831318203 |
| Entity Type | Individual |
| Full Name | MARY NOWACK |
| Credential | PHD |
| Practice Address |
4572 S Hagadorn Rd Ste 2aw East Lansing MI 48823-5385 |
| Mailing Address |
P O Box 2257 Chesterton IN 46304-0357 |
| Practice Telephone | 5173321580 |
| Practice Fax Number | 2199263524 |
| Mailing Telephone | 2199268320 |
| Mailing Fax Number | 2199263524 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-05-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6301003862 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | VALUE OPTIONS | 037962 | 01 |
| MI | SELECT CARE | 179889 | 01 |
| MI | BLUE CROSS BLUE SHIELD | 620C34616 | 01 |
| MI | HEALTH ADVANTAGE | 100 9398 | 01 |
| Street Address |
4572 S HAGADORN RD STE 2AW |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48823-5385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144848631 | Joseph Santangelo | Technician | 2775 E Lansing Dr, East Lansing, MI 48823 | 2020-07-10 |
| 1679197701 | Alexandra Megan Bauer | Technician | 3839 Hunsaker Street, 121, East Lansing, MI 48823 | 2020-06-04 |
| 1689297756 | Nathan Barnhurst | Neuromusculoskeletal Medicine & OMM | 4660 Hagadorn Rd #500, East Lansing, MI 48823 | 2020-05-25 |
| 1861036006 | Rachel Amber Kelly | Registered Nurse | 221 W Lake Rd, #300, East Lansing, MI 48823 | 2019-10-31 |
| 1982176442 | Thomas Patrick Lilley | Occupational Therapist | 2900 Hannah Blvd. - Suite B102, East Lansing, MI 48823 | 2018-12-21 |
| 1386114684 | Anne Colleen Jack | Social Worker | 3100 West Road, East Lansing, MI 48823 | 2018-11-29 |
| 1346721420 | Mary Ann Malosh | Health Educator | 6265 Fenwick Ct, East Lansing, MI 48823 | 2018-08-27 |
| 1639668734 | Jennifer Lynn Box | Occupational Therapist | 2900 Hannah Blvd Ste. B102, Outpatient Rehab, East Lansing, MI 48823 | 2018-05-03 |
| 1598267288 | Wise Willow Counseling & Consulting LLC | Social Worker | 2875 Northwind Dr Ste 215, East Lansing, MI 48823 | 2018-03-08 |
| 1184142010 | Carlrianna Taylor | Technician | 2775 E Lansing Rd, E Lansing, MI 48823 | 2017-08-30 |
| Find all providers in zip 48823 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497126734 | Cynthia Malewska | Psychologist | 1905 Abbot Rd. #1, East Lansing, MI 48823 | 2015-10-13 |
| 1023367877 | Matthew Jerome Orlando | Psychologist | 541 E Grand River Ave Ste E, East Lansing, MI 48823-4445 | 2012-09-06 |
| 1134355639 | Jason S Moser | Psychologist | 316 Physics Rd, East Lansing, MI 48824-5604 | 2009-06-10 |
| 1790931251 | Jacqueline Mezza Titus | Psychologist | 151 Psychology Bldg, Michigan State Psychological Clinic, East Lansing, MI 48824-1116 | 2008-08-14 |
| 1740458504 | Amy Susan Kolberg | Psychologist | 1210 Stonegate Ln, East Lansing, MI 48823-2864 | 2008-02-14 |
| 1831374792 | John R Taylor | Psychologist | 601 Abbot Rd, Suite 101, East Lansing, MI 48823-3366 | 2008-01-09 |
| 1154531440 | Robert Dean Smith | Psychologist | 3505 Coolidge Rd, East Lansing, MI 48823-6377 | 2007-05-23 |
| 1316069438 | Kathi Ann Hull | Psychologist | 2911 Eyde Pkwy, Suite 100, East Lansing, MI 48823-5381 | 2007-04-06 |
| 1093833501 | Nicole Therese Buchanan | Psychologist | 200 Woodland Pass Ste E, East Lansing, MI 48823-2000 | 2007-03-26 |
| 1396898318 | Stuart Lee Doneson | Psychologist | 4572 S Hagadorn Rd Ste 2h, East Lansing, MI 48823-5385 | 2007-01-21 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48823 |
Please comment or provide details below to improve the information on MARY NOWACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.