Provider Demographics
NPI:1780999862
Name:BORCHERDING, MARY J (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:BORCHERDING
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 78TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7444
Mailing Address - Country:US
Mailing Address - Phone:718-456-5450
Mailing Address - Fax:
Practice Address - Street 1:270 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4055
Practice Address - Country:US
Practice Address - Phone:516-937-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist