Provider Demographics
NPI:1760726145
Name:KOVACIC, JACQUELINE L (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:KOVACIC
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 FALCON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2236
Mailing Address - Country:US
Mailing Address - Phone:440-729-3637
Mailing Address - Fax:
Practice Address - Street 1:12395 FALCON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2236
Practice Address - Country:US
Practice Address - Phone:440-554-9332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist