Healthcare Provider Details

I. General information

NPI: 1548749104
Provider Name (Legal Business Name): JANAE L GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTHLAND BLVD
CINCINNATI OH
45246-3675
US

IV. Provider business mailing address

230 NORTHLAND BLVD STE 212
CINCINNATI OH
45246-3752
US

V. Phone/Fax

Practice location:
  • Phone: 937-520-7871
  • Fax:
Mailing address:
  • Phone: 937-520-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2309707
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2302851-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: