Active NPI
Jennifer B. Nowak, M.S., CCC-SLP
- Speech-Language Pathologist
- Poplar Bluff, MO
National Provider Identifier
1235230582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2006011487
- Practice address
- 1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318 - Phone
- (573) 686-4151
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Speech-Language Pathologist | 235Z00000X | SA2618 | FL | |
| Speech-Language Pathologist | 235Z00000X | 2006011487 | MO | Primary |
Addresses
Primary practice location
1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318
Mailing address
1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318
Phone (573) 686-6415
Other practice location 1
786 Highway O
Williamsville, MO 63967-8191
Phone (573) 714-6855
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466291507 | Medicaid | MO | |
| 882188700 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA2618 | FL | MD | Speech-Language Pathologist |
| 2006011487 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1235230582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013318",
"telephone_number": "573-686-6415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013318",
"telephone_number": "573-686-4151"
}
],
"practiceLocations": [
{
"address_1": "786 Highway O",
"address_purpose": "LOCATION",
"city": "Williamsville",
"state": "MO",
"postal_code": "639678191",
"country_code": "US",
"telephone_number": "573-714-6855",
"fax_number": "573-778-0854",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOWAK",
"first_name": "JENNIFER",
"middle_name": "B.",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA2618",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2006011487",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "466291507",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "882188700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.