Provider Demographics
NPI:1487003646
Name:GORDON, SCOTT MORRIS
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MORRIS
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1208
Mailing Address - Country:US
Mailing Address - Phone:717-652-2828
Mailing Address - Fax:717-652-5658
Practice Address - Street 1:6091 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1208
Practice Address - Country:US
Practice Address - Phone:717-652-2828
Practice Address - Fax:717-652-5658
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO2938237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist