Gordon, Jacqueline
Gordon, Jacqueline is an individual health care provider with primary practice located at 3800 S National Ave Ste 700 , Springfield MO 65807-5279. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Gordon, Jacqueline can be contacted via phone (417) 269-8817.Contact Information
Primary practice address
3800 S National Ave Ste 700
Springfield MO 65807-5279
Phone: (417) 269-8817
Fax: (417) 269-8744
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 01758 | Missouri |
Profile Details
| NPI number | 1114923026 |
|---|---|
| LBN Legal business name | Gordon, Jacqueline |
| Credentials | PSYD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2005 |
| Last updated | Jan 12th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114923026 | NPPES |
| Missouri | MEDICAID | 498214014 |
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