Provider Demographics
NPI:1851367445
Name:BORN, PATRICIA (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BORN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 FREEWAY DRIVE
Mailing Address - Street 2:#211
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-428-5009
Mailing Address - Fax:360-428-5710
Practice Address - Street 1:1621 FREEWAY DRIVE
Practice Address - Street 2:#211
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-428-5009
Practice Address - Fax:360-428-5710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003767101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor