Provider Demographics
NPI:1811043060
Name:MARTIN-BOHL, KARYN (LCSW, RN, CADC)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:MARTIN-BOHL
Suffix:
Gender:F
Credentials:LCSW, RN, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S PHELPS AVE
Mailing Address - Street 2:SUITE 812
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2453
Mailing Address - Country:US
Mailing Address - Phone:815-394-1555
Mailing Address - Fax:815-394-1188
Practice Address - Street 1:129 S PHELPS AVE
Practice Address - Street 2:SUITE 812
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2453
Practice Address - Country:US
Practice Address - Phone:815-394-1555
Practice Address - Fax:815-394-1188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0087051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1166Medicare PIN