Gordon, Jerome S

Gordon, Jerome S is an sole proprietor health care provider with primary practice located at 635 Church St Ne , Salem OR 97301-2402. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Gordon, Jerome S can be contacted via phone (503) 399-9691.

Contact Information

Primary practice address
635 Church St Ne Salem OR 97301-2402
Phone: (503) 399-9691
Fax: (503) 399-9401
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 682 Oregon
Behavioral Health & Social Service Providers / Family 103TF0000X 682 Oregon
Behavioral Health & Social Service Providers / Forensic 103TF0200X 682 Oregon
Behavioral Health & Social Service Providers / Psychologist 103T00000X 682 Oregon

Profile Details

NPI number 1427103886
LBN Legal business name Gordon, Jerome S
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 24th, 2007
Last updated Jul 9th, 2007 - about 19 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427103886 NPPES
Oregon MEDICAID 172437

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