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NPI Code Detail

MEDICARE: JESSICA ELIZABETH GORDON

MEDICARE: JESSICA ELIZABETH 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
1101YA0400XAddiction (Substance Use Disorder) CounselorMI
2101YP2500XProfessional Counselor6401018026MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265994206
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ELIZABETH GORDON
Provider Business Mailing Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4597
Country : US
Telephone Number : 517-372-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4597
Country : US
Telephone Number : 517-372-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 05/07/2026

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Directions to “ JESSICA ELIZABETH GORDON ” Practice Location

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