Provider Demographics
NPI:1396102513
Name:GORDON, DEBORAH LYNNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E PEASE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1359
Mailing Address - Country:US
Mailing Address - Phone:937-859-5121
Mailing Address - Fax:937-859-2768
Practice Address - Street 1:510 E PEASE AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1359
Practice Address - Country:US
Practice Address - Phone:937-859-5121
Practice Address - Fax:937-859-2768
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist