Judi Marie Gordon, RN, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

300170 Issued in MN

Practice address

1911 Pleasant Ave. South
Create, Inc
Minneapolis, MN 55403

Phone

(612) 874-9811

Fax

(612) 874-9820

NPI assigned

Jan 22, 2008

Last updated

Jan 22, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Resources for Education Alternative Treatments & Evaluation

  dba CREATE Inc

  • Addiction (Substance Use Disorder) Counselor
  • Minneapolis, MN
  • NPI 1336212653
  NPD (past)
• Create Inc

  • Addiction (Substance Use Disorder) Counselor
  • Plymouth, MN
  • NPI 1730581646
  NPD (past)

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200960000000",
    "number": "1679750608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 PLEASANT AVE. SOUTH",
            "address_2": "CREATE, INC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55403",
            "telephone_number": "612-874-9811",
            "fax_number": "612-874-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 PLEASANT AVE. SOUTH",
            "address_2": "CREATE, INC",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55403",
            "telephone_number": "612-874-9811",
            "fax_number": "612-874-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JUDI",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RN, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-22",
        "last_updated": "2008-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "300170",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R-062487-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC",
            "identifier": "300170",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "R-062487-1",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Rae Gordner
• Kevin Gordon Robles
• Amy R Gordon, NP-C
• Beth Amelia Gordon, OTR
• David Paul Gordon, MSW
• Kelsey Gordon
• Monica Gordon
• Nancy G Gordon, RD LD CDE
• Peter M Gordon, MD, PHD
• Andrea Gore, PT

• Addiction (Substance Use Disorder) Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; 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.