Provider Demographics
NPI:1497552343
Name:KOVARIK, ANGELA CHRISTINE (MED, EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:KOVARIK
Suffix:
Gender:F
Credentials:MED, EDS, NCSP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:LOMBARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 S SAPPINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1005
Mailing Address - Country:US
Mailing Address - Phone:314-729-2400
Mailing Address - Fax:
Practice Address - Street 1:1020 S SAPPINGTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1005
Practice Address - Country:US
Practice Address - Phone:324-729-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO397061103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool