Healthcare Provider Details

I. General information

NPI: 1467506311
Provider Name (Legal Business Name): WENDY PATRICIA KOVACS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E LAKE ST STE 1300
CHICAGO IL
60601-7458
US

IV. Provider business mailing address

70 E LAKE ST STE 1300
CHICAGO IL
60601-7458
US

V. Phone/Fax

Practice location:
  • Phone: 312-726-4011
  • Fax:
Mailing address:
  • Phone: 312-726-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: