Provider Demographics
NPI:1497808026
Name:BORTMAS, KENDRA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNN
Last Name:BORTMAS
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 1:640 MUDDY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-5316
Mailing Address - Country:US
Mailing Address - Phone:724-794-9093
Mailing Address - Fax:
Practice Address - Street 1:114 SKYLINE LN
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-8762
Practice Address - Country:US
Practice Address - Phone:724-283-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006141L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist