Healthcare Provider Details

I. General information

NPI: 1811397235
Provider Name (Legal Business Name): ANNE BORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 HORSESHOE PIKE
PALMYRA PA
17078-9039
US

IV. Provider business mailing address

10600 YORK RD
COCKEYSVILLE MD
21030-2351
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-2231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL010972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: