Basic Information
| Provider Information | |||||||||
| NPI: | 1023260965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVEL | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.S., CCC-SLP/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 CEMETERY RD | ||||||||
| Address2: | |||||||||
| City: | JERSEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620521212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184984828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 FLETCHER ST | ||||||||
| Address2: | |||||||||
| City: | JERSEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620522127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184986427 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.009325 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.