MEDICARE: NICOLETTE ANGELINA BORN M.S-CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SA19218	FL
2	235Z00000X	Speech-Language Pathologist	SL015209	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14334997	OTHER		AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
2	SA19218	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH
3	SL015209	OTHER	PA	COMMONWEALTH OF PA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL

General Provider Information

NPI Number	:	1992322671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE ANGELINA BORN M.S-CCC-SLP

Provider Business Mailing Address
First Line	:	3133 TRIPHAMMER RD
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-9434
Country	:	US
Telephone Number	:	724-710-8907
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 N FRANKLIN DR STE 4-5
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-5874
Country	:	US
Telephone Number	:	724-705-7050
Fax Number	:

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

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	10/16/2021

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Directions to “ NICOLETTE ANGELINA BORN M.S-CCC-SLP” Practice Location

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