Healthcare Provider Details

I. General information

NPI: 1588007066
Provider Name (Legal Business Name): TANESHA D BORGMAN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANESHA D DIXON MA,CCC-SLP

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 BOISE AVE STE 116
LOVELAND CO
80538-4295
US

IV. Provider business mailing address

550 LAVASTONE AVE
LOVELAND CO
80537-5896
US

V. Phone/Fax

Practice location:
  • Phone: 970-235-0538
  • Fax:
Mailing address:
  • Phone: 303-775-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0001196
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: