Active NPI
Samuel Gordon
- Speech-Language Pathologist
- Waconia, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 9346 Oak Ave
Waconia, MN 55387-9422 - Phone
- (952) 442-5812
- NPI assigned
- Mar 21, 2024
- Last updated
- Jun 2, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | MN | Primary |
Addresses
Primary practice location
9346 Oak Ave
Waconia, MN 55387-9422
Mailing address
1243 Edmonson Ave NE Apt 309
Monticello, MN 55362-5509
Phone (919) 939-6303
Other practice location 1
9375 Fenning Ave NE
Monticello, MN 55362-8569
Phone (763) 272-2970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunnydays Therapy Inc | Speech-Language Pathologist | Current | Accepting new patients |
| Mother of Mercy | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Locations
1344 E 7th St
Monticello, MN 55362
9346 Oak Ave
Waconia, MN 55387
Phone (952) 885-0418
Organizations & group practices 3
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.
-
dba CentraCare Occupations Health
- Occupational Medicine Clinic/Center
- Saint Cloud, MN
- NPI 1366192759
-
dba Mother of Mercy Senior Living
- Skilled Nursing Facility
- Albany, MN
- NPI 1104899939
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780358400000",
"number": "1710747001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1243 EDMONSON AVE NE APT 309",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553625509",
"telephone_number": "919-939-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9346 OAK AVE",
"city": "WACONIA",
"state": "MN",
"postal_code": "553879422",
"telephone_number": "952-442-5812"
}
],
"practiceLocations": [
{
"address_1": "9375 Fenning Ave NE",
"address_purpose": "LOCATION",
"city": "Monticello",
"state": "MN",
"postal_code": "553628569",
"country_code": "US",
"telephone_number": "763-272-2970",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GORDON",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-21",
"last_updated": "2026-06-02",
"certification_date": "2026-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.