Chanelle Gordon, PH.D.
Individual provider Active NPI Clinical Psychologist · Omaha, NE
NPI 1023728896 · NPPES record last updated Dec 1, 2022
Key facts
- NPI
- 1023728896
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1006 (NE)
- Practice address
- 14122 Manderson PLZ Apt 107
Omaha, NE 68164-6296 - Phone
- (415) 294-0872
- NPI assigned
- Dec 1, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1006 | NE | Yes |
Addresses
Primary practice location
14122 Manderson PLZ Apt 107
Omaha, NE 68164-6296
Mailing address
14122 Manderson PLZ Apt 107
Omaha, NE 68164-6296
Phone (415) 294-0872
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | securerecords.sanford.html |
Other providers in Omaha, NE
- Gary L Gorby
- Yana Gordeyeva
- Dae'Vyon Gordon-Taplett
- Abigail Susanne Gordon
- Bruce G Gordon
- Chenel D Gordon
- Chidae Seville Gordon
- Denai Gordon
- Denise Nan Gordon
- Erica Gordon
All providers in Omaha, NE · Clinical Psychologist in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.