Active NPI
Kim Marcus Gordon, LCSW
- Clinical Social Worker
- Slidell, LA
National Provider Identifier
1275763021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4592
- Practice address
- 2800 Gause Blvd E
Suite B
Slidell, LA 70461-4247 - Phone
- (504) 319-8247
- NPI assigned
- Jul 14, 2009
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4592 | LA | Primary |
Addresses
Primary practice location
2800 Gause Blvd E
Suite B
Slidell, LA 70461-4247
Mailing address
113 Herring Dr
Slidell, LA 70461-1113
Phone (504) 319-8247
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 |
|---|---|---|---|
| 4592 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247529600000",
"number": "1275763021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 HERRING DR",
"city": "SLIDELL",
"state": "LA",
"postal_code": "704611113",
"telephone_number": "504-319-8247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 GAUSE BLVD E",
"address_2": "SUITE B",
"city": "SLIDELL",
"state": "LA",
"postal_code": "704614247",
"telephone_number": "504-319-8247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KIM",
"middle_name": "MARCUS",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-14",
"last_updated": "2009-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "4592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Slidell, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.