Provider Demographics
NPI:1407534753
Name:GORDON, VASHELLE DENISE
Entity Type:Individual
Prefix:
First Name:VASHELLE
Middle Name:DENISE
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 1:116 DUFRENSE DR
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-5248
Mailing Address - Country:US
Mailing Address - Phone:225-206-3684
Mailing Address - Fax:
Practice Address - Street 1:116 DUFRENSE DR
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-5248
Practice Address - Country:US
Practice Address - Phone:225-206-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator