Healthcare Provider Details

I. General information

NPI: 1508614785
Provider Name (Legal Business Name): PAMELA BORRESON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 GAYLE WAY
GRANTS PASS OR
97527-4262
US

IV. Provider business mailing address

1055 REDWOOD AVE
GRANTS PASS OR
97527-5525
US

V. Phone/Fax

Practice location:
  • Phone: 541-232-3237
  • Fax:
Mailing address:
  • Phone: 541-479-0545
  • Fax: 542-479-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10600
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: