Provider Demographics
NPI:1164924478
Name:BORGMAN, MELINDA SUE (CRM)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 SE 85TH
Mailing Address - Street 2:312
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-621-4132
Mailing Address - Fax:
Practice Address - Street 1:10763 SW GREENBURG RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5492
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:503-598-0934
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health