Provider Demographics
NPI:1538452503
Name:LONERGAN, MONICA (SLP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1005
Mailing Address - Country:US
Mailing Address - Phone:309-672-4568
Mailing Address - Fax:309-672-4569
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-672-4568
Practice Address - Fax:309-672-4569
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist