Healthcare Provider Details

I. General information

NPI: 1477283224
Provider Name (Legal Business Name): CORY AUGUST BORSDORF LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 N KERMAN DR
PARK CITY KS
67219-1507
US

IV. Provider business mailing address

6725 N KERMAN DR
PARK CITY KS
67219-1507
US

V. Phone/Fax

Practice location:
  • Phone: 316-755-6902
  • Fax:
Mailing address:
  • Phone: 316-755-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07376
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: