Provider Demographics
NPI:1780344135
Name:BONICA, CARLY QUINTEN
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:QUINTEN
Last Name:BONICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:QUINTEN
Other - Last Name:CATALANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 N HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5223
Mailing Address - Country:US
Mailing Address - Phone:708-941-9996
Mailing Address - Fax:
Practice Address - Street 1:5 REVERE DRIVE, ONE NORTHBROOK PLACE SUITE 200
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8000
Practice Address - Country:US
Practice Address - Phone:512-377-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120561235Z00000X
IL146.016329235Z00000X
WI6174-154235Z00000X
MO2023006211235Z00000X
MN1024580235Z00000X
WI1001447229235Z00000X
IL2483958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist