Provider Demographics
NPI:1770601247
Name:KOVALSKY, MARCIE A (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:A
Last Name:KOVALSKY
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 1:514 ORCHARD STREET
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946
Mailing Address - Country:US
Mailing Address - Phone:814-421-2754
Mailing Address - Fax:814-736-8039
Practice Address - Street 1:514 ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946
Practice Address - Country:US
Practice Address - Phone:814-421-2754
Practice Address - Fax:814-736-8039
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001836235OtherHIGHMARK BLUE CROSS BLUE