Provider Demographics
NPI:1164114906
Name:GORDON, KAYTLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10942 VARGAS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4948
Mailing Address - Country:US
Mailing Address - Phone:217-294-3536
Mailing Address - Fax:
Practice Address - Street 1:10942 VARGAS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-4948
Practice Address - Country:US
Practice Address - Phone:217-294-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool