Provider Demographics
NPI:1104119379
Name:DORKA, MEGHAN J
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:J
Last Name:DORKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:J
Other - Last Name:LIBKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4109 NORTH LOWELL
Mailing Address - Street 2:UNIT 2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-6234
Mailing Address - Country:US
Mailing Address - Phone:773-443-9201
Mailing Address - Fax:
Practice Address - Street 1:2737 N MILDRED AVE
Practice Address - Street 2:APT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6234
Practice Address - Country:US
Practice Address - Phone:810-602-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-22
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist