Provider Demographics
NPI:1497103857
Name:HOHENBOKEN, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HOHENBOKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 317TH ST N
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61257-9703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21615 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6670
Practice Address - Country:US
Practice Address - Phone:310-371-8555
Practice Address - Fax:310-371-4488
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist