Provider Demographics
NPI:1518266162
Name:KOVAR, ADRIENNE M (LICSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:KOVAR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 LAKE ST S
Mailing Address - Street 2:STE 109
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2633
Mailing Address - Country:US
Mailing Address - Phone:651-982-4792
Mailing Address - Fax:651-982-6035
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:STE 109
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2633
Practice Address - Country:US
Practice Address - Phone:651-982-4792
Practice Address - Fax:651-982-6035
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical