Provider Demographics
NPI:1609509942
Name:GORDON, WILLIAM JACOB (MSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACOB
Last Name:GORDON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:J
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11776 E 530 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-5496
Mailing Address - Country:US
Mailing Address - Phone:918-855-7606
Mailing Address - Fax:
Practice Address - Street 1:1728 S CARSON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4610
Practice Address - Country:US
Practice Address - Phone:918-406-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator