Jenny Lyle Gordon

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP006776 Issued in GA

Practice address

121B Lee St
Carrollton, GA 30117-3314

Phone

(770) 830-8622

Fax

(770) 832-9031

NPI assigned

Dec 20, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Pediatric Therapy Partners of Wga

  • Occupational Therapist
  • Carrollton, GA
  • NPI 1568697613
  NPD (past)

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1710161179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2548 OLD NEWNAN RD",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301169020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121B LEE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173314",
            "telephone_number": "770-830-8622",
            "fax_number": "770-832-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JENNY",
        "middle_name": "LYLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-20",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126664544A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Goodbodys Minor Med Express Care
• Jonathan M Goodin, MD
• Gwyndolyn B. Goodwin, D.C.
• Gordon T. Austin, D.M.D., P.C.
• Jefferson Taylor Gordon, M.D.
• Olivia Katelyn Gordon, MS, RD, LD
• Pam J Gordon, BS
• Robin Wilson Gordon, LPC
• Bridget Nicole Green Gordy, FNP , RN
• Amy Reed Goss, M.D.

• Speech-Language Pathologist in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.