Eric L. Gordon, M.S. CCC/SLP
Individual provider Active NPI Speech-Language Pathologist · Charlestown, IN
NPI 1316176209 · NPPES record last updated Jul 13, 2009
Key facts
- NPI
- 1316176209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22002489 (IN)
- Practice address
- 4604 Lake Forest Dr
Charlestown, IN 47111-9033 - Phone
- (812) 796-9029
- Fax
- (812) 796-9029
- NPI assigned
- Jul 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
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
| License | State | Type | Specialty |
|---|---|---|---|
| 22002489 | IN | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22002489 | IN | Yes |
Addresses
Primary practice location
4604 Lake Forest Dr
Charlestown, IN 47111-9033
Mailing address
4604 Lake Forest Dr
Charlestown, IN 47111-9033
Phone (812) 796-9029
Other providers in Charlestown, IN
- Heather Gibson
- Christina Ranea Gilkey
- Raymie Charles Gill
- Rae Jeanna Godsey
- Lea Goodin
- Laurhyn Griebel
- Travis Lee Gross
- Michael Grubbs
- Alyssa Evans Gullion
- Stephanie Lynn Hardy
All providers in Charlestown, IN · Speech-Language Pathologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.