Healthcare Provider Details

I. General information

NPI: 1366307878
Provider Name (Legal Business Name): LYNNAE GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 WINTER GARDEN VINELAND RD STE 112
WINTER GARDEN FL
34787-4449
US

IV. Provider business mailing address

1905 SUNSET PALM DR
APOPKA FL
32712-8188
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: