Provider Demographics
NPI:1427365048
Name:COVENTRY, DANA
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:COVENTRY
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 1:2432 PRAIRIE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4057
Mailing Address - Country:US
Mailing Address - Phone:630-892-6298
Mailing Address - Fax:
Practice Address - Street 1:2432 PRAIRIE CROSSING DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4057
Practice Address - Country:US
Practice Address - Phone:630-892-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150-012043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker