Active NPI
Jerome S Gordon, PH.D.
- Family Psychologist
- Salem, OR
National Provider Identifier
1427103886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Psychologist
- License
- 682
- Practice address
- 635 Church St NE
Salem, OR 97301-2402 - Phone
- (503) 399-9691
- Fax
- (503) 399-9401
- NPI assigned
- Jan 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 682 | OR | |
| Family Psychologist | 103TF0000X | 682 | OR | Primary |
| Forensic Psychologist | 103TF0200X | 682 | OR | |
| Psychologist | 103T00000X | 682 | OR |
Addresses
Primary practice location
635 Church St NE
Salem, OR 97301-2402
Mailing address
635 Church St NE
Salem, OR 97301-2402
Phone (503) 399-9691
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 172437 | Medicaid | OR |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 682 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1427103886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 CHURCH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012402",
"telephone_number": "503-399-9691",
"fax_number": "503-399-9401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 CHURCH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973012402",
"telephone_number": "503-399-9691",
"fax_number": "503-399-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JEROME",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "682",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "OR",
"license": "682",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "OR",
"license": "682",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "682",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "172437",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.