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General NPI Number Information
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NPI Number | 1780344135
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Entity Type | Individual
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Provider Name | CARLY QUINTEN BONICA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 5 REVERE DRIVE, ONE NORTHBROOK PLACE SUITE 200
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City | NORTHBROOK
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State | IL
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Zip | 60062-8000
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Country | US
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Telephone | 512-377-6318
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Fax |
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Provider Business Mailing Address
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Address Line | 825 N HARVARD AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-5223
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Country | US
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Telephone | 708-941-9996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 120561
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6174-154
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2023006211
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1024580
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1001447229
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2483958
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.016329
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License Number State | IL
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