Provider Demographics
NPI:1033413620
Name:KOVACH, THERESE M (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:KOVACH
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:KOVACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:10780 ZUNI DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3161
Mailing Address - Country:US
Mailing Address - Phone:303-909-9655
Mailing Address - Fax:
Practice Address - Street 1:10780 ZUNI DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3161
Practice Address - Country:US
Practice Address - Phone:303-909-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist