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General NPI Number Information
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NPI Number | 1770222986
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Entity Type | Individual
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Provider Name | SUSAN JENSEN KOVAKA LPC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2022
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 7251 SAWMILL RD
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City | DUBLIN
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State | OH
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Zip | 43016-7406
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Country | US
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Telephone | 614-766-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 275 THAMES CT
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City | LONDON
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State | OH
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Zip | 43140-9519
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Country | US
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Telephone | 502-727-2871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2505199
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License Number State | OH
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