Individual provider Active NPI

Christopher William Borsellino, MS CCC-SLP

  • Speech-Language Pathologist
  • Las Vegas, NV
National Provider Identifier
1487811576
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP-1142 Issued in NV
Practice address
330 E Warm Springs Rd Ste 122
Las Vegas, NV 89119-4281
Phone
(702) 979-4268
Fax
(702) 979-1336
NPI assigned
May 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP-1142 NV Primary

Addresses

Primary practice location

330 E Warm Springs Rd Ste 122
Las Vegas, NV 89119-4281

Mailing address

330 E Warm Springs Rd Ste 122
Las Vegas, NV 89119-4281
Phone (725) 255-5321

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SP-1142NVMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Indigo-Bane LLC Speech-Language Pathologist CurrentSince Jan 19, 2025 Accepting new patients

Locations

330 E Warm Springs Rd
Ste 122
Las Vegas, NV 89119
Phone (702) 979-4268

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1487811576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E WARM SPRINGS RD STE 122",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891194281",
            "telephone_number": "725-255-5321",
            "fax_number": "702-255-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E WARM SPRINGS RD STE 122",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891194281",
            "telephone_number": "702-979-4268",
            "fax_number": "702-979-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORSELLINO",
        "first_name": "CHRISTOPHER",
        "middle_name": "WILLIAM",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-18",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NV",
            "license": "SP-1142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.