Provider Demographics
NPI:1083643977
Name:BORKOWSKI, GILLIAN ANNE (MED)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:ANNE
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:GILLIAN
Other - Middle Name:ANNE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:P O BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:616-942-1660
Mailing Address - Fax:616-942-5796
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE # 230
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-942-1660
Practice Address - Fax:616-942-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002688231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083643977Medicaid
MI1083643977Medicaid
MIN71920015Medicare PIN