Provider Demographics
NPI:1023373925
Name:GORDON, RACHEL (CFY)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FUSTING AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4413
Mailing Address - Country:US
Mailing Address - Phone:410-747-1800
Mailing Address - Fax:
Practice Address - Street 1:16 FUSTING AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4413
Practice Address - Country:US
Practice Address - Phone:410-747-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDXIK904346995OtherCARE FIRST BLUE CHOICE
MD44304404800Medicaid