Healthcare Provider Details

I. General information

NPI: 1497552343
Provider Name (Legal Business Name): ANGELA CHRISTINE KOVARIK MED, EDS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANGELA CHRISTINE LOMBARDO

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S SAPPINGTON RD
SAINT LOUIS MO
63126-1005
US

IV. Provider business mailing address

1020 S SAPPINGTON RD
SAINT LOUIS MO
63126-1005
US

V. Phone/Fax

Practice location:
  • Phone: 324-729-2400
  • Fax:
Mailing address:
  • Phone: 314-729-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number397061
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: