Provider Demographics
NPI:1275882615
Name:BORTON, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PROFESSIONAL WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6581
Mailing Address - Country:US
Mailing Address - Phone:561-651-9614
Mailing Address - Fax:561-355-0343
Practice Address - Street 1:255 PROFESSIONAL WAY STE 200
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6581
Practice Address - Country:US
Practice Address - Phone:561-651-9614
Practice Address - Fax:561-355-0343
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist