Basic Information
| Provider Information | |||||||||
| NPI: | 1891088589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORNER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Credential: | M.S. CFY SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 E. INDIAN SCHOOL RD. | ||||||||
| Address2: | AUDIOLOGY AND SPEECH PATHOLOGY (126) | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 E. INDIAN SCHOOL ROAD | ||||||||
| Address2: | AUDIOLOGY AND SPEECH PATHOLOGY (126) | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2011 | ||||||||
| LastUpdateDate: | 11/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | TSLP7236 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.