MEDICARE: ADRIAN GORDON CPSS

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	175T00000X	Peer Specialist	F25-118400	UT

General Provider Information

NPI Number	:	1376485870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN GORDON CPSS

Provider Business Mailing Address
First Line	:	718 E WILSON AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3123
Country	:	US
Telephone Number	:	385-465-0497
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 E FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1531
Country	:	US
Telephone Number	:	385-275-6162
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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