Provider Demographics
NPI:1750626156
Name:BORGES, JENNIFER MARIE (BS, SLP-A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BORGES
Suffix:
Gender:F
Credentials:BS, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GRAND ARMY HWY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1210
Mailing Address - Country:US
Mailing Address - Phone:508-677-9797
Mailing Address - Fax:508-677-9922
Practice Address - Street 1:1610 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1210
Practice Address - Country:US
Practice Address - Phone:508-677-9797
Practice Address - Fax:508-677-9922
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7022355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant