Doctor Name: | MRS. BRENDA LEE GORDON |
NPI Number: | 1114130853 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCCSLP |
License Number: | MO01639 |
Business Practice Address: | 1901a Buena Vista Ave Carthage, MO - 648363178 |
Business Phone Number: | 4173583440 |
Business Fax Number: | 4173595617 |
Mailing Address: | 10088 Deer Wood Dr, JOPLIN |
State: | MO |
Postal Code: | 648048359 |
Phone Number: | 4176244325 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 10/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | MO01639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |