Provider Demographics
NPI:1811031990
Name:BOREN, GRACE DALY (CCC SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:DALY
Last Name:BOREN
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 1:15 THREE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1334
Mailing Address - Country:US
Mailing Address - Phone:631-751-3188
Mailing Address - Fax:
Practice Address - Street 1:15 THREE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1334
Practice Address - Country:US
Practice Address - Phone:631-751-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist