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General NPI Number Information
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NPI Number | 1760833586
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Entity Type | Individual
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Provider Name | ELAINA ROSE GORDON M.S
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 944 FIELDS DR STE 102
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5341
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Country | US
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Telephone | 502-380-7297
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Fax |
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Provider Business Mailing Address
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Address Line | 632 NUTWOOD ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-1620
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Country | US
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Telephone | 502-380-7297
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 167247
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License Number State | KY
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