Healthcare Provider Details

I. General information

NPI: 1508313503
Provider Name (Legal Business Name): KATHLEEN BORDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 NW TROOST ST
ROSEBURG OR
97471-7704
US

IV. Provider business mailing address

3015 SW SALMON AVE
REDMOND OR
97756-8004
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax:
Mailing address:
  • Phone: 425-761-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60497216
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932433
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11753
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: