Provider Demographics
NPI:1861892945
Name:BORGEN, JOHN (PSYD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BORGEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-0356
Mailing Address - Country:US
Mailing Address - Phone:715-869-1718
Mailing Address - Fax:
Practice Address - Street 1:1699 SCHOFIELD AVE STE 120
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2332
Practice Address - Country:US
Practice Address - Phone:402-559-8863
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5380-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical