Provider Demographics
NPI:1578948642
Name:FOGARTY, KAREN DENISE
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DENISE
Last Name:FOGARTY
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 1:550 W FRONTAGE RD
Mailing Address - Street 2:SUITE 2810
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1202
Mailing Address - Country:US
Mailing Address - Phone:847-501-2528
Mailing Address - Fax:
Practice Address - Street 1:550 W FRONTAGE RD
Practice Address - Street 2:SUITE 2810
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1202
Practice Address - Country:US
Practice Address - Phone:847-501-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490178551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical