Active NPI
Widalys Borges
- Speech-Language Pathologist
- Independence, KY
National Provider Identifier
1407224066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 11490
- Practice address
- 91 Fleming Dr
Independence, KY 41051-8509 - Phone
- (513) 550-7820
- NPI assigned
- Sep 11, 2015
- Last updated
- Sep 11, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 11490 | OH | Primary |
Addresses
Primary practice location
91 Fleming Dr
Independence, KY 41051-8509
Mailing address
91 Fleming Dr
Independence, KY 41051-8509
Phone (513) 550-7820
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11490 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11490 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441929600000",
"number": "1407224066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 FLEMING DR",
"city": "INDEPENDENCE",
"state": "KY",
"postal_code": "410518509",
"telephone_number": "513-550-7820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 FLEMING DR",
"city": "INDEPENDENCE",
"state": "KY",
"postal_code": "410518509",
"telephone_number": "513-550-7820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORGES",
"first_name": "WIDALYS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-11",
"last_updated": "2015-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "11490",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11490",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Independence, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.