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General NPI Number Information
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NPI Number | 1104119379
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Entity Type | Individual
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Provider Name | MS. MEGHAN J DORKA
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Gender | Female
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Dates
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Enumeration Date | 05/22/2011
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 2737 N MILDRED AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60614-6234
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Country | US
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Telephone | 810-602-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 NORTH LOWELL UNIT 2F
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City | CHICAGO
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State | IL
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Zip | 60641-6234
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Country | US
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Telephone | 773-443-9201
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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 | 146010113
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License Number State | IL
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