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General NPI Number Information
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NPI Number | 1013918465
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Entity Type | Individual
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Provider Name | VIRGINIA KLEIN GORDON MSW
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/22/2014
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Provider Practice Location Address
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Address Line | 464 CENTRAL AVE
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City | NORTHFIELD
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State | IL
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Zip | 60093-3040
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Country | US
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Telephone | 847-433-5133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 813
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-0813
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Country | US
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Telephone | 847-433-5133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149002571
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License Number State | IL
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