| Doctor Name: | MS. KRYSTAL MI'CHAL GORDON |
| NPI Number: | 1366513012 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | ASW20095 |
| Business Practice Address: | 546 W Compton Blvd Compton, CA - 902203011 |
| Business Phone Number: | 3108852117 |
| Business Fax Number: | 3105379653 |
| Mailing Address: | Po Box 3044, LAKEWOOD |
| State: | CA |
| Postal Code: | 907113044 |
| Phone Number: | 3108852117 |
| Fax Number: | 3105379653 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | ASW20095 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |