Provider Demographics
NPI:1457770224
Name:D. GORDON AND ASSOCIATES
Entity type:Organization
Organization Name:D. GORDON AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-566-1702
Mailing Address - Street 1:5325 S HYDE PARK BLVD
Mailing Address - Street 2:3C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5720
Mailing Address - Country:US
Mailing Address - Phone:312-566-1702
Mailing Address - Fax:
Practice Address - Street 1:1323 E 50TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2905
Practice Address - Country:US
Practice Address - Phone:312-566-1702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490154151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7859Medicare UPIN