Healthcare Provider Details

I. General information

NPI: 1780093898
Provider Name (Legal Business Name): MAISIE GORDON M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27650 CASHFORD CIR
WESLEY CHAPEL FL
33544-6957
US

IV. Provider business mailing address

13101 BRUCE B DOWNS BLVD
TAMPA FL
33612-3803
US

V. Phone/Fax

Practice location:
  • Phone: 813-963-6923
  • Fax:
Mailing address:
  • Phone: 813-974-0602
  • Fax: 813-558-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10515
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA21105
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: