Provider Demographics
NPI:1083175616
Name:GORDON, HAYLEY CHRISTINE- LOUISE (MS , BCBA)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:CHRISTINE- LOUISE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS , BCBA
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Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3105 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1015
Practice Address - Country:US
Practice Address - Phone:470-241-1353
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33494OtherBCBA CERTIFICATE