Provider Demographics
NPI:1508858721
Name:BORGEN, KRISTIN K (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:K
Last Name:BORGEN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1457 WESTGREEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9661
Mailing Address - Country:US
Mailing Address - Phone:920-757-5972
Mailing Address - Fax:
Practice Address - Street 1:1520 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3762
Practice Address - Country:US
Practice Address - Phone:920-734-7181
Practice Address - Fax:920-734-0621
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI289156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41132000Medicaid