Provider Demographics
NPI:1285043661
Name:GORDON, CHERYL (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 WARNER RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9475
Mailing Address - Country:US
Mailing Address - Phone:740-816-4444
Mailing Address - Fax:
Practice Address - Street 1:9340 WARNER RD
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-9475
Practice Address - Country:US
Practice Address - Phone:740-816-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered