Provider Demographics
NPI:1215366539
Name:SOVAK, ANGELA FAYE (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:FAYE
Last Name:SOVAK
Suffix:
Gender:F
Credentials:PSYD LP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7390 BUTTERSCOTCH RD # 2
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3233
Mailing Address - Country:US
Mailing Address - Phone:612-314-6241
Mailing Address - Fax:612-230-1235
Practice Address - Street 1:9531 W 78TH ST STE 340
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-8001
Practice Address - Country:US
Practice Address - Phone:612-314-6241
Practice Address - Fax:612-230-1235
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP5693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist