Provider Demographics
NPI:1992033062
Name:PACHECO, ANNE BORDELON (HEARING AID SPECIALI)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:BORDELON
Last Name:PACHECO
Suffix:
Gender:F
Credentials:HEARING AID SPECIALI
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:BORDELON
Other - Last Name:MERKL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:612-351-1529
Mailing Address - Fax:
Practice Address - Street 1:350 NW EASTMAN PKWY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7203
Practice Address - Country:US
Practice Address - Phone:503-667-3832
Practice Address - Fax:503-465-4768
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR237600000X
ORHAS-P-10129545237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORHAS-P-10129545OtherOREGON HEALTH LICENSE