Provider Demographics
NPI:1699494013
Name:BORREGO, MICHELLE L
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BORREGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N CROSSLEY ST
Mailing Address - Street 2:
Mailing Address - City:MELVIN
Mailing Address - State:IL
Mailing Address - Zip Code:60952-4004
Mailing Address - Country:US
Mailing Address - Phone:217-379-7661
Mailing Address - Fax:
Practice Address - Street 1:304 N CROSSLEY ST
Practice Address - Street 2:
Practice Address - City:MELVIN
Practice Address - State:IL
Practice Address - Zip Code:60952-4004
Practice Address - Country:US
Practice Address - Phone:217-379-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker