MEDICARE: YUKI BORT

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	2355S0801X	Speech-Language Assistant	66767	CO

General Provider Information

NPI Number	:	1205363025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUKI BORT

Provider Business Mailing Address
First Line	:	5551 CORNERSTONE DR UNIT E29
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5551 CORNERSTONE DR UNIT E29
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3098
Country	:	US
Telephone Number	:	970-778-4637
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “ YUKI BORT ” Practice Location

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