Provider Demographics
NPI:1013001551
Name:BORTON, BETTIE B (AUD)
Entity Type:Individual
Prefix:DR
First Name:BETTIE
Middle Name:B
Last Name:BORTON
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 1:450 HARRIS CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-8218
Mailing Address - Country:US
Mailing Address - Phone:334-615-5799
Mailing Address - Fax:
Practice Address - Street 1:4220 OCOEE ST N STE 102
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4829
Practice Address - Country:US
Practice Address - Phone:423-641-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A0000001957231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I641614Medicare PIN