Healthcare Provider Details

I. General information

NPI: 1952451528
Provider Name (Legal Business Name): LISA ANN KOVAL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 COLLEGE PKWY
COLCHESTER VT
05446-3007
US

IV. Provider business mailing address

348 LAKE RD
SAINT ALBANS VT
05478-2267
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3940
  • Fax:
Mailing address:
  • Phone: 802-524-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: