Provider Demographics
NPI:1215086053
Name:BOREN, MICHELLE HILL (MSCCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HILL
Last Name:BOREN
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2529
Mailing Address - Country:US
Mailing Address - Phone:502-349-6961
Mailing Address - Fax:502-348-1789
Practice Address - Street 1:105 HERITAGE PARK WAY
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-819-1391
Practice Address - Fax:502-348-1789
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2346235Z00000X
KY140274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist