Healthcare Provider Details

I. General information

NPI: 1629347869
Provider Name (Legal Business Name): EILEEN MARIE GORDON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN MARIE CREMERING AU.D.

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N GRAND AVE SUITE 101
FORT THOMAS KY
41075-4107
US

IV. Provider business mailing address

40 N GRAND AVE SUITE 103
FORT THOMAS KY
41075-4107
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-4900
  • Fax: 859-572-3039
Mailing address:
  • Phone: 859-781-4900
  • Fax: 859-572-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0526
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: