Provider Demographics
NPI:1851626162
Name:DOHERTY, KARLA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:MARIE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MARNE RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4590
Mailing Address - Country:US
Mailing Address - Phone:630-759-7398
Mailing Address - Fax:630-759-7396
Practice Address - Street 1:1820 MARNE RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4590
Practice Address - Country:US
Practice Address - Phone:630-759-7398
Practice Address - Fax:630-759-7396
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist