Healthcare Provider Details

I. General information

NPI: 1861724767
Provider Name (Legal Business Name): MEGAN BURGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KRISTOFF

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14635 PENNOCK AVE STE 300
APPLE VALLEY MN
55124-6588
US

IV. Provider business mailing address

14635 PENNOCK AVE STE 300
APPLE VALLEY MN
55124-6588
US

V. Phone/Fax

Practice location:
  • Phone: 651-994-9644
  • Fax: 815-725-9993
Mailing address:
  • Phone: 651-994-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-3911
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: