NPIMap

Organization Active NPI

Bordeaux SLP & Consulting, LLC

Doing business as Mke SLP

  • Speech-Language Pathologist
  • West Bend, WI
National Provider Identifier
1558909556
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BORDEAUX SLP & CONSULTING, LLC
Doing business as
Mke SLP
Wisconsin AAC Services
Practice address
1624 Barton Ave
West Bend, WI 53090
Phone
(414) 368-0449
NPI assigned
Dec 20, 2019
Last updated
Dec 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Authorized official

Name
Mr. Andrew Russell Bordeaux, M.S., CCC-SLPNPI 1801142732
Title
Speech-Language Pathologist
Phone
(414) 617-2696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

1624 Barton Ave
West Bend, WI 53090

Mailing address

PO Box 504
Germantown, WI 53022-0504

Other names 2

  • MKE SLP Doing business as
  • Wisconsin AAC Services Doing business as

National Provider Directory

National Provider Directory

Locations

1624 Barton Ave
West Bend, WI 53090
Phone (414) 368-0449

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576800000000",
    "number": "1558909556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530220504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 BARTON AVE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "53090",
            "telephone_number": "414-368-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORDEAUX SLP & CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "BORDEAUX",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "414-617-2696",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MKE SLP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MKE SLP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wisconsin AAC Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.