Provider Demographics
NPI:1225436009
Name:GORDON, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 INLET COVE CT
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9728
Mailing Address - Country:US
Mailing Address - Phone:813-943-7735
Mailing Address - Fax:
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:6-7
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7154
Practice Address - Country:US
Practice Address - Phone:727-869-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 6904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist