Active NPI
Ashley Elizabeth Bordelon, PH.D.
- Clinical Child & Adolescent Psychologist
- Klamath Falls, OR
National Provider Identifier
1720138019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 3201
- Practice address
- 501 Main St Ste 202
Klamath Falls, OR 97601-6035 - Phone
- (541) 891-7823
- Fax
- (844) 955-2526
- NPI assigned
- Jan 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | 3201 | OR | Primary |
Addresses
Primary practice location
501 Main St Ste 202
Klamath Falls, OR 97601-6035
Mailing address
501 Main St Ste 202
Klamath Falls, OR 97601-6035
Phone (541) 891-7823
Other practice location 1
1600 Broad Ave
Gulfport, MS 39501-3603
Phone (228) 863-1132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018213 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Sep 6, 2023 through Sep 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593302400000",
"number": "1720138019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 MAIN ST STE 202",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016035",
"telephone_number": "541-891-7823",
"fax_number": "844-955-2526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 MAIN ST STE 202",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016035",
"telephone_number": "541-891-7823",
"fax_number": "844-955-2526"
}
],
"practiceLocations": [
{
"address_1": "1600 Broad Ave",
"address_purpose": "LOCATION",
"city": "Gulfport",
"state": "MS",
"postal_code": "395013603",
"country_code": "US",
"telephone_number": "228-863-1132",
"fax_number": "228-865-1700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BORDELON",
"first_name": "ASHLEY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2020-06-28",
"certification_date": "2020-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "3201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00018213",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.