Healthcare Provider Details

I. General information

NPI: 1497955850
Provider Name (Legal Business Name): LORI KAY KOVACS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SW 75TH ST STE 30
GAINESVILLE FL
32607-3467
US

IV. Provider business mailing address

1016 SPRING VILLAS PT STE. 1030
WINTER SPRINGS FL
32708-5258
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-1195
  • Fax:
Mailing address:
  • Phone: 407-629-9455
  • Fax: 407-629-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: