Provider Demographics
NPI:1992789515
Name:BORG, JULIE (PSYD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BORG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MCGINNIS-BORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA030OtherCHAMPUS
MN287G4MCOtherBLUE PLUS
MN287G4MCOtherBLUE CROSS
MN7306OtherAVERA
MN862667OtherARAZ
MN121810Medicaid
MNMH9041010744OtherPREFERREDONE
MNHP28362OtherHEALTHPARTNERS
MN287G4MCMedicare ID - Type UnspecifiedBC MEDICRE SUPPLEMENT