Provider Demographics
NPI:1649334046
Name:BORST, BRENDA L (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BORST
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEIGH
Other - Last Name:ELLSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5718 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1135
Mailing Address - Country:US
Mailing Address - Phone:814-942-7714
Mailing Address - Fax:
Practice Address - Street 1:208 LAKEMONT PARK BLVD
Practice Address - Street 2:EARLY INTERVENTION
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist