Provider Demographics
NPI:1659518314
Name:KOVIAN, THERESA MARIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIA
Last Name:KOVIAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-0763
Mailing Address - Country:US
Mailing Address - Phone:518-424-1425
Mailing Address - Fax:
Practice Address - Street 1:33 HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2217
Practice Address - Country:US
Practice Address - Phone:518-424-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist