Provider Demographics
NPI:1811205784
Name:BORNSTEIN, MARGARET ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARGARET
Middle Name:ROSE
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:BORNSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:ME
Mailing Address - Zip Code:04284-0251
Mailing Address - Country:US
Mailing Address - Phone:207-592-3046
Mailing Address - Fax:
Practice Address - Street 1:169 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-7037
Practice Address - Country:US
Practice Address - Phone:207-933-4426
Practice Address - Fax:207-933-7279
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist