1689990855 NPI number — MRS. NANCY REDMAN BORELLI MA, CCC-SLP

Table of content: MRS. NANCY REDMAN BORELLI MA, CCC-SLP (NPI 1689990855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689990855 NPI number — MRS. NANCY REDMAN BORELLI MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORELLI
Provider First Name:
NANCY
Provider Middle Name:
REDMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDMAN
Provider Other First Name:
NANCY
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689990855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11942 PRADERA RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93012-9387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-907-6523
Provider Business Mailing Address Fax Number:
818-763-3890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11942 PRADERA RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93012-9387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-907-6523
Provider Business Practice Location Address Fax Number:
818-763-3890
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP562 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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