MEDICARE: MS. VONDA BAILEY 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	104100000X	Social Worker

Other Identifiers

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

General Provider Information

NPI Number	:	1356475800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VONDA BAILEY GORDON

Provider Business Mailing Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-409-2136
Fax Number	:	321-409-2140

Provider Business Practice Location Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-409-2136
Fax Number	:	321-409-2140

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/16/2013

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Directions to “ MS. VONDA BAILEY GORDON ” Practice Location

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