Provider Demographics
NPI:1548573355
Name:BORGELT, DEBRA ANN (CADC II/CRM/PSS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BORGELT
Suffix:
Gender:F
Credentials:CADC II/CRM/PSS
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:ANN
Other - Last Name:BORGELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC II/CRM/PSS
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:971-386-2278
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-CRM-184101YA0400X
ORTHW000001271175T00000X
OR06-11-72101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670029Medicaid
OR500725965Medicaid