Mallory Margret Gordon, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

L417827 Issued in MI

Practice address

19900 E. 10 Mile Rd.
Ste. 102
Saint Clair Shores, MI 48080

Phone

(586) 776-3366

Fax

(586) 776-3369

NPI assigned

Aug 19, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Mallory Margret Gardner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1669871364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19900 E. 10 MILE RD.",
            "address_2": "STE. 102",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-776-3366",
            "fax_number": "586-776-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19900 E. 10 MILE RD.",
            "address_2": "STE. 102",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-776-3366",
            "fax_number": "586-776-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MALLORY",
        "middle_name": "MARGRET",
        "name_prefix": "Mrs.",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-19",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "L417827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "GARDNER",
            "middle_name": "MARGRET",
            "prefix": "MS.",
            "credential": "LLLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard N Goich, DPM
• Ian Goldsbrough, MS, LPC
• Christopher S Goldsby, MD
• Raylynn Marie Gonzales
• Kimberly Lynn Goodwin, BSN, MRC, CRC, LPC
• Robert Allen Gordy, MOT
• Marc Oliver Gosselin, DO
• Kevin J Grady, M.D.
• Meagan Grammatico, MT-BC
• Rebecca Mae Grammatico, PA-C

• Clinical Psychologist in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.