MEDICARE: ADRIENNE M KOVAR LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	18862	MN

General Provider Information

NPI Number	:	1518266162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE M KOVAR LICSW

Provider Business Mailing Address
First Line	:	1068 LAKE ST S
Second Line	:	STE 109
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2633
Country	:	US
Telephone Number	:	651-982-4792
Fax Number	:	651-982-6035

Provider Business Practice Location Address
First Line	:	1068 LAKE ST S
Second Line	:	STE 109
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2633
Country	:	US
Telephone Number	:	651-982-4792
Fax Number	:	651-982-6035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	02/16/2024

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