Provider Demographics
NPI:1003268574
Name:THORNBURGH, MEGHAN C
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:C
Last Name:THORNBURGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:F
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-0354
Mailing Address - Country:US
Mailing Address - Phone:910-673-5437
Mailing Address - Fax:910-673-5438
Practice Address - Street 1:1163 7 LAKES DR
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-5437
Practice Address - Fax:910-673-5438
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5906235Z00000X
NC13106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist