Healthcare Provider Details

I. General information

NPI: 1043122583
Provider Name (Legal Business Name): RICHARD D BORDERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 US HIGHWAY 51 S
ANNA IL
62906-3483
US

IV. Provider business mailing address

1000 US HIGHWAY 51 S
ANNA IL
62906-3483
US

V. Phone/Fax

Practice location:
  • Phone: 618-614-3334
  • Fax:
Mailing address:
  • Phone: 618-614-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: