Provider Demographics
NPI:1184632457
Name:GORDON, CAROL ELLEN (PSYD,CADC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELLEN
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 N ARLINGTON HEIGHTS RD STE 502
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1586
Mailing Address - Country:US
Mailing Address - Phone:847-815-4299
Mailing Address - Fax:847-418-8948
Practice Address - Street 1:3255 N ARLINGTON HEIGHTS RD STE 502
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1586
Practice Address - Country:US
Practice Address - Phone:847-815-4299
Practice Address - Fax:847-418-8948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211846Medicare PIN