Individual provider Active NPI

Aubrey Marie Gordon, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Sidney, OH
National Provider Identifier
1164079380
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.171164 Issued in OH
Practice address
1101 N Vandemark Rd
Sidney, OH 45365-3567
Phone
(937) 492-8080
NPI assigned
Aug 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.171164 OH Primary

Addresses

Primary practice location

1101 N Vandemark Rd
Sidney, OH 45365-3567

Mailing address

438 W Plum St
Tipp City, OH 45371-1848
Phone (937) 216-4559

Other practice location 1

438 W Plum St
Tipp City, OH 45371-1848
Phone (937) 216-4559

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

LicenseStateTypeSpecialty
CDCA.171164OHMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1164079380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 W PLUM ST",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453711848",
            "telephone_number": "937-216-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N VANDEMARK RD",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653567",
            "telephone_number": "937-492-8080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "438 W Plum St",
            "address_purpose": "LOCATION",
            "city": "Tipp City",
            "state": "OH",
            "postal_code": "453711848",
            "country_code": "US",
            "telephone_number": "937-216-4559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "AUBREY",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-22",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.171164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sidney, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; 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.