Healthcare Provider Details

I. General information

NPI: 1700699378
Provider Name (Legal Business Name): ZACHARY BORDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZAK BORDEN

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 S CENTRAL POINT RD
CANBY OR
97013-8705
US

IV. Provider business mailing address

6536 SE DUKE ST
PORTLAND OR
97206-6665
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-4531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: