Provider Demographics
NPI:1255476297
Name:KOVALIK, KAREN
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:KOVALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 S NATIONAL AVE
Mailing Address - Street 2:# 1705
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2687
Mailing Address - Country:US
Mailing Address - Phone:619-549-6296
Mailing Address - Fax:
Practice Address - Street 1:608 S PICKWICK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3339
Practice Address - Country:US
Practice Address - Phone:417-862-2273
Practice Address - Fax:417-862-8659
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist