Provider Demographics
NPI:1205993821
Name:MONICA KARNEBOGE ORAL MOTOR CLINIC
Entity type:Organization
Organization Name:MONICA KARNEBOGE ORAL MOTOR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KARNEBOGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:815-485-0111
Mailing Address - Street 1:430 W FRANCIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1013
Mailing Address - Country:US
Mailing Address - Phone:815-485-0111
Mailing Address - Fax:815-485-0111
Practice Address - Street 1:430 W FRANCIS RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1013
Practice Address - Country:US
Practice Address - Phone:815-485-0111
Practice Address - Fax:815-485-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09915120OtherBLUE CROSS BLUE SHIELD