1114432960 NPI number — MRS. RUTH ANNE BOROWSKI-RISKEDAHL X B.S. CADC I, CGAC I

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114432960 NPI number — MRS. RUTH ANNE BOROWSKI-RISKEDAHL X B.S. CADC I, CGAC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOROWSKI-RISKEDAHL
Provider First Name:
RUTH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
X
Provider Credential Text:
B.S. CADC I, CGAC I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOROWSKI-RISKEDAHL
Provider Other First Name:
RUTH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
X
Provider Other Credential Text:
B.S. CADC I, CGAC I,
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114432960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29500 SW MONTEBELLO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSONVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97070-7577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-975-0828
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-245-6262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  14-07-17U , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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