Provider Demographics
NPI:1093564080
Name:GORDON, KALEIGH CHRISTIAN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:CHRISTIAN
Last Name:GORDON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AVALON WAY APT 904
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7488
Mailing Address - Country:US
Mailing Address - Phone:601-966-7619
Mailing Address - Fax:
Practice Address - Street 1:4215 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9212
Practice Address - Country:US
Practice Address - Phone:601-932-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist