Provider Demographics
NPI:1093328106
Name:GORDON, SANDRA J (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TY LN
Mailing Address - Street 2:
Mailing Address - City:PENACOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1049
Mailing Address - Country:US
Mailing Address - Phone:603-717-8324
Mailing Address - Fax:
Practice Address - Street 1:25 TY LN
Practice Address - Street 2:
Practice Address - City:PENACOOK
Practice Address - State:NH
Practice Address - Zip Code:03303-1049
Practice Address - Country:US
Practice Address - Phone:603-717-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist