Provider Demographics
NPI:1053544338
Name:BORTS, TATYANA (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:
Last Name:BORTS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 STRICKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6428
Mailing Address - Country:US
Mailing Address - Phone:917-855-8875
Mailing Address - Fax:718-209-8693
Practice Address - Street 1:2709 STRICKLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6428
Practice Address - Country:US
Practice Address - Phone:917-855-8875
Practice Address - Fax:718-209-8693
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist