Healthcare Provider Details

I. General information

NPI: 1972410314
Provider Name (Legal Business Name): TEDDI LEE KOVACEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 N 400 E STE A105
SAINT GEORGE UT
84770-7192
US

IV. Provider business mailing address

2711 W 390 N
HURRICANE UT
84737-3471
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-8890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: