Provider Demographics
NPI:1629214259
Name:KOVACIK, JANIELLE ZINNA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANIELLE
Middle Name:ZINNA
Last Name:KOVACIK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JANIELLE
Other - Middle Name:
Other - Last Name:ZINNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:248 DEPEW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2968
Mailing Address - Country:US
Mailing Address - Phone:845-893-9102
Mailing Address - Fax:
Practice Address - Street 1:248 DEPEW AVE APT 2
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2968
Practice Address - Country:US
Practice Address - Phone:845-893-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03660102Medicaid