Provider Demographics
NPI:1285288324
Name:GORDON, JOSEPH LEE ROY JR (DSHS, CCHI)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE ROY
Last Name:GORDON
Suffix:JR
Gender:M
Credentials:DSHS, CCHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 NE 4TH ST UNIT 2738
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-9997
Mailing Address - Country:US
Mailing Address - Phone:206-200-9916
Mailing Address - Fax:
Practice Address - Street 1:5132 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4099
Practice Address - Country:US
Practice Address - Phone:206-200-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter