MEDICARE: JACLYN MENZEL BORCHARDT 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	2849154	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669694998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN MENZEL BORCHARDT M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1834 W WISCONSIN AVE
Second Line	:	LOWER LEVEL
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2125
Country	:	US
Telephone Number	:	414-933-9813
Fax Number	:	414-933-1522

Provider Business Practice Location Address
First Line	:	1834 W WISCONSIN AVE
Second Line	:	LOWER LEVEL
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2125
Country	:	US
Telephone Number	:	414-933-9813
Fax Number	:	414-933-1522

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/02/2009

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Directions to “ JACLYN MENZEL BORCHARDT M.S. CCC-SLP” Practice Location

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