Provider Demographics
NPI:1871159111
Name:BORKENHAGEN, MARY ANN MARGARET
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:MARGARET
Last Name:BORKENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY ANN
Other - Middle Name:MARGARET
Other - Last Name:MEANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 DANI CT
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1608
Mailing Address - Country:US
Mailing Address - Phone:815-690-6417
Mailing Address - Fax:
Practice Address - Street 1:3 DANI CT
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1608
Practice Address - Country:US
Practice Address - Phone:815-690-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist