Wade Gordon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-27205 Issued in ID

Practice address

310 N 2ND E
Suite 128
Rexburg, ID 83440-1600

Phone

(208) 356-5675

Fax

(208) 356-5675

NPI assigned

Jun 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Fork Services, LLC

  • Community/Behavioral Health Agency
  • Rexburg, ID
  • NPI 1588006217
  NPD (past) Authorized official

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376740134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N 2ND E",
            "address_2": "SUITE 128",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401600",
            "telephone_number": "208-356-5675",
            "fax_number": "208-356-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N 2ND E",
            "address_2": "SUITE 128",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401600",
            "telephone_number": "208-356-5675",
            "fax_number": "208-356-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "WADE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-27205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin C Gillette
• Cheryl Gimmeson
• Natalya Gonzales
• Christina Goodman, PA
• Kyler Scott Goodman
• Kyle Joe Gould
• Janiel J Green, PA-C
• Greenstone Counseling LLC
• Samantha Gregston, LCSW
• Kirsten Lee Griggs, LCPC

• Clinical Social Worker in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.