MEDICARE: ELIZABETH NICHOLE GORDON MA, CFY-SLP

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		FL

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	:	1972114916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NICHOLE GORDON MA, CFY-SLP

Provider Business Mailing Address
First Line	:	PO BOX 120547
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34712-0547
Country	:	US
Telephone Number	:	352-394-0212
Fax Number	:	352-241-6361

Provider Business Practice Location Address
First Line	:	5125 ADANSON ST STE 750
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-1327
Country	:	US
Telephone Number	:	352-394-0212
Fax Number	:	352-241-6361

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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