Provider Demographics
NPI:1336252410
Name:BORDERS, CHRIS R (MA CCC A)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:R
Last Name:BORDERS
Suffix:
Gender:F
Credentials:MA 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:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0004
Mailing Address - Country:US
Mailing Address - Phone:425-391-3343
Mailing Address - Fax:425-391-5692
Practice Address - Street 1:49 FRONT ST N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-3343
Practice Address - Fax:425-391-5692
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD0001043231H00000X
231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0198132OtherL&I
WAG8852938Medicare PIN