Healthcare Provider Details

I. General information

NPI: 1689632044
Provider Name (Legal Business Name): CARRIE M BORCHARDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH SMITH AVENUE CHILDREN'S SPECIALTY CLINIC PSYCHOLOGICAL SERVICES STPL
ST. PAUL MN
55102
US

IV. Provider business mailing address

2910 CENTRE POINTE DRIVE 35-121A CHILDREN'S HEALTH CARE
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6720
  • Fax: 651-220-6707
Mailing address:
  • Phone: 651-855-2327
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29055
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number29055
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: