Provider Demographics
NPI:1689562662
Name:LACOVARA, AMIE LYNN
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:LYNN
Last Name:LACOVARA
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 1:1528 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3854
Mailing Address - Country:US
Mailing Address - Phone:484-947-4810
Mailing Address - Fax:
Practice Address - Street 1:6320 CANOGA AVE STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2517
Practice Address - Country:US
Practice Address - Phone:818-732-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist