Provider Demographics
NPI:1669194635
Name:KOVICH, ALISON LEIGH (RDN)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LEIGH
Last Name:KOVICH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 LYNDON DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6593
Mailing Address - Country:US
Mailing Address - Phone:937-271-5570
Mailing Address - Fax:
Practice Address - Street 1:2670 MILLS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3593
Practice Address - Country:US
Practice Address - Phone:803-366-4848
Practice Address - Fax:803-325-1612
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006641133V00000X
SCLRD2436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered