| Doctor Name: | SUZETTE LORRAINE GORDON |
| NPI Number: | 1831346469 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NM LSP |
| License Number: | 220939 |
| Business Practice Address: | 1607 W. Aztec Blvd. Aztec Municipal Schools Aztec, NM - 87410 |
| Business Phone Number: | 5053341730 |
| Business Fax Number: | |
| Mailing Address: | 1607 W. Aztec Blvd., Aztec Municipal Schools AZTEC |
| State: | NM |
| Postal Code: | 87410 |
| Phone Number: | 5053341730 |
| Fax Number: | |
| NPI Enumeration Date: | 08/26/2008 |
| NPI Last Update Date: | 08/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 220939 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |