Healthcare Provider Details

I. General information

NPI: 1174017925
Provider Name (Legal Business Name): MEGAN BOERBOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 IRVING ST
DENVER CO
80211-3632
US

IV. Provider business mailing address

5995 E ILIFF AVE APT 306
DENVER CO
80222-5725
US

V. Phone/Fax

Practice location:
  • Phone: 720-355-1081
  • Fax:
Mailing address:
  • Phone: 507-530-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: