Provider Demographics
NPI:1770719478
Name:BORDERS, CARL EDISON III (CCC-SLP/L)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:EDISON
Last Name:BORDERS
Suffix:III
Gender:M
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 SPEYER LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4730
Mailing Address - Country:US
Mailing Address - Phone:310-971-7416
Mailing Address - Fax:
Practice Address - Street 1:1724 SPEYER LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4730
Practice Address - Country:US
Practice Address - Phone:310-971-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist