Carly Gordon, M.A.
Individual provider Active NPI Speech-Language Pathologist · Piedmont, CA
NPI 1457734626 · NPPES record last updated Nov 17, 2020
Key facts
- NPI
- 1457734626
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SP-1478 (HI)
- Practice address
- Telemedicine Service
15 Olive Ave
Piedmont, CA 94611-4427 - Phone
- (209) 210-8262
- NPI assigned
- Jul 6, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-1478 | HI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bakersfield Memorial Hospital | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP-1478 | HI | Yes |
Addresses
Primary practice location
Telemedicine Service
15 Olive Ave
Piedmont, CA 94611-4427
Mailing address
15 Olive Ave # 11
Piedmont, CA 94611-4427
Phone (209) 210-8262
Other providers in Piedmont, CA
- Claudia P Garcia
- Amy Garfinkle
- Lauren Godfrey
- Daniel H Golden
- Nicole Gonzales
- Corie Gould
- Megan Graham
- Amy Whalen Griffith
- Mary Jane Gross
- Christopher Guerisoli
All providers in Piedmont, CA · Speech-Language Pathologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2020. 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.