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General NPI Number Information
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NPI Number | 1861869646
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Entity Type | Organization
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Legal Business Name | NEAL J GORDON EDD SC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 4105 RUTGERS LN
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City | NORTHBROOK
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State | IL
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Zip | 60062-2911
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Country | US
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Telephone | 708-383-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 RUTGERS LN
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City | NORTHBROOK
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State | IL
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Zip | 60062-2911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEAL GORDON
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Credential |
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Telephone | 847-668-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.002067
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License Number State | IL
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