Provider Demographics
NPI:1770868861
Name:KOVARY-FRANK, MERIDITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:MERIDITH
Middle Name:
Last Name:KOVARY-FRANK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-6631
Mailing Address - Fax:630-933-4936
Practice Address - Street 1:25 N WINFIELD RD.
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-6631
Practice Address - Fax:630-933-4936
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008258103TC0700X
DCPSY1000721103TC2200X
NY019221103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL206147086OtherMEDICARE PTAN (INDIVIDUAL)