Andrew Russell Bordeaux, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3708-154 Issued in WI

Practice address

1624 Barton Ave
West Bend, WI 53090

Phone

(414) 368-0449

NPI assigned

Jul 30, 2012

Last updated

Dec 20, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

• Bordeaux SLP & Consulting, LLC

  dba Mke SLP

  • Speech-Language Pathologist
  • West Bend, WI
  • NPI 1558909556
  Authorized official Same address or phone

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1801142732",
    "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",
            "telephone_number": "414-617-2696"
        },
        {
            "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": {
        "last_name": "BORDEAUX",
        "first_name": "ANDREW",
        "middle_name": "RUSSELL",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-30",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "3708-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Bodien, PT
• Emily Louise Boettcher, LPC
• Elizabeth Marie Bohn
• Julie Bolha, PPCNP-BC
• Bordeaux SLP & Consulting, LLC (Mke SLP)
• Allyssa L Bosse, LPC
• Lisa S Bosshard, MD
• Irene Isabel Bozich, M.D.
• Lenore Elizabeth Brahm, DO
• Sarah Braun Otten, MS

• Speech-Language Pathologist in West Bend, WI
• Providers in West Bend, WI by specialty
• Speech-Language Pathologist in Wisconsin

• 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.