Active NPI
Mary Elizabeth Gordon, SLP
- Speech-Language Pathologist
- Omaha, NE
National Provider Identifier
1174247308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 794
- Practice address
- 11623 Arbor St Ste 200
Omaha, NE 68144-2991 - Phone
- (402) 334-6063
- Fax
- (402) 334-6063
- NPI assigned
- Sep 30, 2022
- 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 | 794 | NE | Primary |
Addresses
Primary practice location
11623 Arbor St Ste 200
Omaha, NE 68144-2991
Mailing address
11623 Arbor St Ste 200
Omaha, NE 68144-2991
Phone (402) 334-6063
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 794 | NE | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1174247308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11623 ARBOR ST STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681442991",
"telephone_number": "402-334-6063",
"fax_number": "023-346-0634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11623 ARBOR ST STE 200",
"city": "OMAHA",
"state": "NE",
"postal_code": "681442991",
"telephone_number": "402-334-6063",
"fax_number": "402-334-6063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-30",
"last_updated": "2022-09-30",
"certification_date": "2022-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NE",
"license": "794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.