Healthcare Provider Details

I. General information

NPI: 1790109064
Provider Name (Legal Business Name): KATHRYN SPORING KOVACH LPC, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN SPORING KOVACH

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 HULL ST
BALTIMORE MD
21230-5263
US

IV. Provider business mailing address

1413 HULL ST
BALTIMORE MD
21230-5263
US

V. Phone/Fax

Practice location:
  • Phone: 503-308-1538
  • Fax:
Mailing address:
  • Phone: 503-308-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16731
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR6392
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7415
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA00582
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: