Provider Demographics
NPI:1487866117
Name:KOVACS, PATTY (LAC)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:KOVACS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E 4TH AVE
Mailing Address - Street 2:STE 508
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1190
Mailing Address - Country:US
Mailing Address - Phone:360-754-1476
Mailing Address - Fax:360-754-3963
Practice Address - Street 1:203 E 4TH AVE
Practice Address - Street 2:STE 508
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-1190
Practice Address - Country:US
Practice Address - Phone:360-754-1476
Practice Address - Fax:360-754-3963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist