Provider Demographics
NPI:1376672873
Name:MAGNAN, KARLA BONKOWSKI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:BONKOWSKI
Last Name:MAGNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 DUANE ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4510
Mailing Address - Country:US
Mailing Address - Phone:630-469-2000
Mailing Address - Fax:630-469-0452
Practice Address - Street 1:450 DUANE ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4510
Practice Address - Country:US
Practice Address - Phone:630-469-2000
Practice Address - Fax:630-469-0452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0104821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical