Provider Demographics
NPI:1619175213
Name:KOVACH, EVA M (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 W 165TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4238
Mailing Address - Country:US
Mailing Address - Phone:216-671-4366
Mailing Address - Fax:
Practice Address - Street 1:43 E BRIDGE ST STE 203
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-3001
Practice Address - Country:US
Practice Address - Phone:440-891-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist