Provider Demographics
NPI:1649268731
Name:LIBICH, KAREN (MA)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:LIBICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 PARK AVE W
Mailing Address - Street 2:4 SOUTH
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:847-432-5555
Mailing Address - Fax:847-432-5554
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:4 SOUTH
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2230
Practice Address - Country:US
Practice Address - Phone:847-432-5555
Practice Address - Fax:847-432-5554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL88373Medicare ID - Type Unspecified