Active NPI
Alexis Borodin
- Speech-Language Pathologist
- Loves Park, IL
National Provider Identifier
1851880363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146013480
- Practice address
- 1405 Maple Ave
Loves Park, IL 61111-3006 - Phone
- (815) 654-4502
- NPI assigned
- May 9, 2018
- Reactivated
- Aug 27, 2024
- 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 | 146013480 | IL | Primary |
Addresses
Primary practice location
1405 Maple Ave
Loves Park, IL 61111-3006
Mailing address
6389 Green Needle Dr
Loves Park, IL 61111-7119
Phone (724) 219-5722
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 |
|---|---|---|---|
| 146013480 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1851880363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6389 GREEN NEEDLE DR",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611117119",
"telephone_number": "724-219-5722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 MAPLE AVE",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611113006",
"telephone_number": "815-654-4502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORODIN",
"first_name": "ALEXIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-09",
"last_updated": "2024-08-27",
"deactivation_date": "2018-07-09",
"reactivation_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146013480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.