Provider Demographics
NPI:1083753644
Name:GORDON, AMY NICOLE (LM, MSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:NICOLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LM, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N 3RD ST
Mailing Address - Street 2:APT. E
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1934
Mailing Address - Country:US
Mailing Address - Phone:253-213-9472
Mailing Address - Fax:253-752-6245
Practice Address - Street 1:6002 WESTGATE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2570
Practice Address - Country:US
Practice Address - Phone:253-312-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000264176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife