Provider Demographics
NPI:1922482520
Name:BORUTY, MEAGAN DENISE (MS)
Entity Type:Individual
Prefix:MISS
First Name:MEAGAN
Middle Name:DENISE
Last Name:BORUTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14423 IRONSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7248
Mailing Address - Country:US
Mailing Address - Phone:405-642-6570
Mailing Address - Fax:
Practice Address - Street 1:3108 S ROUTE 59
Practice Address - Street 2:SUITE 124-123
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8021
Practice Address - Country:US
Practice Address - Phone:630-318-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist