MEDICARE: MS. LYNDA KAY BORCHERS MA LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP3627	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38Q05B0	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518168111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNDA KAY BORCHERS MA LP

Provider Business Mailing Address
First Line	:	2346 78TH STREET EAST
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2818
Country	:	US
Telephone Number	:	651-387-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 78TH STREET EAST
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2818
Country	:	US
Telephone Number	:	651-387-7122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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