1598582355 NPI number — JACQUELINE JENE KOVACEVIC LMSW

Table of content: JACQUELINE JENE KOVACEVIC LMSW (NPI 1598582355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598582355 NPI number — JACQUELINE JENE KOVACEVIC LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVACEVIC
Provider First Name:
JACQUELINE
Provider Middle Name:
JENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598582355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 WESTOWN PKWY STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50265-1539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-531-0800
Provider Business Mailing Address Fax Number:
515-531-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 WESTOWN PKWY STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50265-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-531-0800
Provider Business Practice Location Address Fax Number:
515-531-0900
Provider Enumeration Date:
09/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  113045 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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