JACQUELINE GORDON (NPI# 1114923026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114923026 |
| Entity Type | Individual |
| Full Name | JACQUELINE GORDON |
| Credential | PSYD |
| Practice Address |
1423 N Jefferson Ave Ste A-100 Springfield MO 65802-1917 |
| Practice Telephone | 4172698787 |
| Practice Fax Number | 4172698750 |
| Mailing Telephone | 4172698787 |
| Mailing Fax Number | 4172698750 |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
01758 | MO | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 498214014 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1300 E Bradford Pkwy, Springfield, MO 658044264 | 4172695400 | 4172697212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770949307 | Jacqueline Gordon | Counselor | 1402 Tevin Way, Madera, CA 93637-6508 | 2016-01-12 |
| 1295954972 | Jacqueline Carol Gordon | Marriage & Family Therapist | 43537 Ridge Park Dr, Temecula, CA 92590-3615 | 2007-04-24 |
| 1528551330 | Jacqueline Ann Gordon | Counselor | 7301 Poe Ave, Dayton, OH 45414-2559 | 2018-06-07 |
| 1457706285 | Jacqueline Gordon | Counselor | 9235 Lake Forest Blvd, Suite A, New Orleans, LA 70127-3043 | 2016-04-29 |
| 1104241488 | Jacqueline Gordon | Physical Therapy Assistant | 6400 N Santa Fe Ave Ste B, Oklahoma City, OK 73116-9126 | 2014-02-24 |
| 1760429401 | Jacqueline Gordon | Pharmacist | 17903 Linden Blvd, Jamaica, NY 11425-0001 | 2006-06-01 |
| Street Address |
1423 N JEFFERSON AVE STE A-100 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65802-1917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454549 | Andrea Strauch | Counselor | 2024 W Chestnut Expressway Way, Springfield, MO 65802 | 2020-10-12 |
| 1962968867 | Chad Michael Linck | Specialist/Technologist | 2125 N Glenstone Ave, Springfield, MO 65802 | 2019-02-15 |
| 1790254647 | Meds To Live By | Pharmacist | 1134 N. Scarlett Way, Springfield, MO 65802 | 2018-11-21 |
| 1568945103 | Ficom | Non-Pharmacy Dispensing Site | 1308 North Glenstone Avenue, Springfield, MO 65802 | 2018-09-10 |
| 1982194775 | Karla Caballero | Marriage & Family Therapist | 8627 Montant Fort Way, 145, Sprinfield, MO 65802 | 2018-05-16 |
| 1780191809 | Tiffany Chawntay Coryell | Pharmacist | 1134 North Scarlett Way, Springfield, MO 65802 | 2018-01-10 |
| 1083134902 | Trevor Conner | Family Medicine | 1423 N Jefferson Ave, B100, Springfield, MO 65802 | 2017-06-21 |
| 1407389596 | Medical Mile Imaging | Radiology | 3905 E Windsmore Dr, Springfield, MO 65802 | 2017-04-06 |
| 1346619103 | Jill A Knight | Occupational Therapist | 1601 E. Pythian, Green Valley State School, Springfield, MO 65802 | 2015-09-22 |
| 1447653258 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3720 E Sunshine St, Springfield, MO 65802 | 2014-10-07 |
| Find all providers in zip 65802 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710509187 | Laura M Maggio | Psychologist | 11 Stephanie Cir, Springfield, MA 01129-1961 | 2020-05-08 |
| 1215556386 | Lotus Healing Center LLC | Psychologist | 28 Millburn Ave Ste 6, Springfield, NJ 07081-1023 | 2020-04-09 |
| 1194359216 | Kathrin A Koehler | Psychologist | 4674 Hominy Ridge Rd, Springfield, OH 45502-8031 | 2020-02-27 |
| 1689126120 | Assessment Consultants, LLC | Psychologist | 2146 W Chesterfield Blvd Ste E202, Springfield, MO 65807-8650 | 2016-11-01 |
| 1003366436 | Caitriona Hayes | Psychologist | 8134 Old Keene Mill Road, Suite 101, Springfield, VA 22152 | 2016-10-10 |
| 1669929907 | Richart Lipe Demier | Psychologist | 5871 S Northern Ridge Rd, Springfield, MO 65810-1976 | 2016-09-03 |
| 1043660905 | Safe Harbor Christian Counseling of Northern Virginia LLC | Psychologist | 8304 Old Keene Mill Rd, Springfield, VA 22152-1640 | 2016-06-21 |
| 1659786432 | Kimberly Wilkins Psyd LLC | Psychologist | 1344 W Oakville Rd, Springfield, MO 65810-1696 | 2014-06-30 |
| 1548507817 | Bahn and Associates | Psychologist | 3000 Professional Dr Ste D, Bahn Consulting, Inc., Springfield, IL 62703-5931 | 2013-01-07 |
| 1396004990 | Cultivate Psychological Services LLC | Psychologist | 1439 S Rogers Ave, Springfield, MO 65804-1129 | 2012-05-16 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65802 |
Please comment or provide details below to improve the information on JACQUELINE GORDON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.