Healthcare Provider Details

I. General information

NPI: 1801924451
Provider Name (Legal Business Name): JENNIFER LYNN KOVACS ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 CANFIELD RD
YOUNGSTOWN OH
44511-2800
US

IV. Provider business mailing address

111 GRISWOLD DR
BOARDMAN OH
44512-2826
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-6298
  • Fax: 330-799-4867
Mailing address:
  • Phone: 330-758-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP7398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: