Chanelle Gordon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1006 Issued in NE

Practice address

14122 Manderson PLZ Apt 107
Omaha, NE 68164-6296

Phone

(415) 294-0872

NPI assigned

Dec 1, 2022

Last updated

Dec 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1023728896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14122 MANDERSON PLZ APT 107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681646296",
            "telephone_number": "415-294-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14122 MANDERSON PLZ APT 107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681646296",
            "telephone_number": "415-294-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CHANELLE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NE",
            "license": "1006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "securerecords.sanford.html",
            "affiliation": "N",
            "address_1": "14122 Manderson Plz Apt 107",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681646296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gary L Gorby, M.D.
• Yana Gordeyeva, MD
• Dae'Vyon Gordon-Taplett
• Abigail Susanne Gordon
• Bruce G Gordon, MD
• Chenel D Gordon
• Chidae Seville Gordon
• Denai Gordon, MD
• Denise Nan Gordon, CRNA
• Erica Gordon

• Clinical Psychologist in Omaha, NE
• Providers in Omaha, NE by specialty
• Clinical Psychologist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.