Individual
MADISON NOVACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 SE DIVISION ST, PORTLAND, OR 97202-1146
(503) 517-8663
Mailing address
1904 SE DIVISION ST, PORTLAND, OR 97202-1146
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104100000X
SOCIAL WORKER
OR
Enumeration date
06/22/2021
Last updated
06/22/2021
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