Provider Demographics
NPI:1124224688
Name:GORDON, STEPHANIE R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3146
Mailing Address - Country:US
Mailing Address - Phone:406-756-3950
Mailing Address - Fax:406-756-3957
Practice Address - Street 1:200 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3146
Practice Address - Country:US
Practice Address - Phone:406-756-3950
Practice Address - Fax:406-756-3957
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical