Active NPI
Bridget Moss Gordon, M.S. CCC-SLP
- Speech-Language Pathologist
- Peoria, AZ
National Provider Identifier
1821134834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 15928
- Practice address
- 13260 N 94TH Dr
Suite 104
Peoria, AZ 85381-4828 - Phone
- (623) 974-8900
- Fax
- (623) 974-8911
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- 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 | 15928 | CA | Primary |
Addresses
Primary practice location
13260 N 94TH Dr
Suite 104
Peoria, AZ 85381-4828
Mailing address
11722 West Mariposa Grande
Sun City, AZ 85373
Phone (623) 444-5207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0913750 | Other | AZ | BLUE CROSS BLUE SHIELD AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15928 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1821134834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11722 WEST MARIPOSA GRANDE",
"city": "SUN CITY",
"state": "AZ",
"postal_code": "85373",
"telephone_number": "623-444-5207",
"fax_number": "623-974-8911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13260 N 94TH DR",
"address_2": "SUITE 104",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814828",
"telephone_number": "623-974-8900",
"fax_number": "623-974-8911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "BRIDGET",
"middle_name": "MOSS",
"name_prefix": "Mrs.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "15928",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD AZ",
"identifier": "AZ0913750",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.