Provider Demographics
NPI:1821052960
Name:BORER, KATHLEEN MARGARET (RN, LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:BORER
Suffix:
Gender:F
Credentials:RN, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2405 KALANIANAOLE ST PH 6
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4905
Mailing Address - Country:US
Mailing Address - Phone:207-991-8237
Mailing Address - Fax:
Practice Address - Street 1:14730 COBALT ST NW UNIT 12
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-3032
Practice Address - Country:US
Practice Address - Phone:207-991-8237
Practice Address - Fax:207-512-1672
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI40911041C0700X
MN164371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821052960OtherBLUE CROSS BLUE SHIELD OF MINNESOTA
MN1821052960OtherHEALTH PARTNERS
MN1821052960OtherUNITED HEALTHCARE
MN1821052960OtherOPTUM
MN877621100Medicaid