Healthcare Provider Details

I. General information

NPI: 1447523972
Provider Name (Legal Business Name): MICHELLE GORDON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-9748
US

IV. Provider business mailing address

80 N TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-9748
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-7788
  • Fax: 360-877-2035
Mailing address:
  • Phone: 360-426-7788
  • Fax: 360-877-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00008880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: