Brenda Lee Gordon, MS CCCSLP

Key facts

NPI

1114130853

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

MO01639 (MO)

Practice address

1901A Buena Vista Ave
Carthage, MO 64836-3178

Phone

(417) 358-3440

Fax

(417) 359-5617

NPI assigned

May 8, 2007

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carthage Rehab, LLC Rehabilitation Clinic/Center · Carthage, MO · NPI 1225182066
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 18, 2007.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1114130853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10088 DEER WOOD DR",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648048359",
            "telephone_number": "417-624-4325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901A BUENA VISTA AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648363178",
            "telephone_number": "417-358-3440",
            "fax_number": "417-359-5617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "BRENDA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "MS CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "MO01639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Carthage, MO · Speech-Language Pathologist in Missouri