MEDICARE: MS. HEATHER BORSDORF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124343942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER BORSDORF

Provider Business Mailing Address
First Line	:	403 W CENTRAL AVE STE A
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-9614
Country	:	US
Telephone Number	:	316-213-2994
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 W CENTRAL AVE STE A
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-9614
Country	:	US
Telephone Number	:	316-213-2994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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Directions to “ MS. HEATHER BORSDORF ” Practice Location

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