MEDICARE: JENNA MARIE GORDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1235072497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MARIE GORDON

Provider Business Mailing Address
First Line	:	2208 COUNTY ROAD 715N
Second Line	:
City	:	CASEY
State	:	IL
Zip	:	62420-4132
Country	:	US
Telephone Number	:	217-549-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W POLK AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2557
Country	:	US
Telephone Number	:	217-639-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ JENNA MARIE GORDON ” Practice Location

Language	Start Address	Practice Location

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