Active NPI
Niketa Gordon
- Speech-Language Pathologist
- Waldorf, MD
National Provider Identifier
1124420419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 01028L
- Practice address
- 4140 Old Washington Rd
Waldorf, MD 20602-3221 - Phone
- (301) 645-2813
- Fax
- (301) 645-9317
- NPI assigned
- Sep 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 01028L | MD | Primary |
Addresses
Primary practice location
4140 Old Washington Rd
Waldorf, MD 20602-3221
Mailing address
4140 Old Washington Rd
Waldorf, MD 20602-3221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01028L | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411430400000",
"number": "1124420419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4140 OLD WASHINGTON RD",
"city": "WALDORF",
"state": "MD",
"postal_code": "206023221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4140 OLD WASHINGTON RD",
"city": "WALDORF",
"state": "MD",
"postal_code": "206023221",
"telephone_number": "301-645-2813",
"fax_number": "301-645-9317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "NIKETA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-18",
"last_updated": "2014-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "01028L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.