Provider Demographics
NPI:1235726654
Name:BOOTH, MEGAN BROOKING (AUD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BROOKING
Last Name:BOOTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:RIMROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86335-1146
Mailing Address - Country:US
Mailing Address - Phone:218-790-4151
Mailing Address - Fax:
Practice Address - Street 1:6446 STATE ROUTE 179 STE 209
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7991
Practice Address - Country:US
Practice Address - Phone:928-284-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA12505231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA