Provider Demographics
NPI:1366594111
Name:KOVACIK, DAWN R (MA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:KOVACIK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W HIGGINS RD
Mailing Address - Street 2:STE 895
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2071
Mailing Address - Country:US
Mailing Address - Phone:847-843-1900
Mailing Address - Fax:
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:STE.206
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-744-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000011231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist