Provider Demographics
NPI:1588345144
Name:BORGEN, MERCEDES JO (EDUCATION SPECIALIST)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:JO
Last Name:BORGEN
Suffix:
Gender:F
Credentials:EDUCATION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10145 LARAMIE LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERSET
Mailing Address - State:SD
Mailing Address - Zip Code:57718-4701
Mailing Address - Country:US
Mailing Address - Phone:701-240-4749
Mailing Address - Fax:
Practice Address - Street 1:433 MOUNT RUSHMORE ROAD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-394-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD82731103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool