Provider Demographics
NPI:1306122981
Name:BORST, MICHELE LEIGH (SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEIGH
Last Name:BORST
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WATERBURY RD
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-4901
Mailing Address - Country:US
Mailing Address - Phone:518-295-7164
Mailing Address - Fax:
Practice Address - Street 1:136 ACADEMY DRIVE
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-4901
Practice Address - Country:US
Practice Address - Phone:518-295-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0141561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist