Individual
VICKI RAE NOVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8669 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 379-0444
(651) 379-0448
Mailing address
8669 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 379-0444
(651) 379-0448
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
416K6NO
BCBS OF MN ID
MN
Enumeration date
02/13/2007
Last updated
12/30/2011
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