Provider Demographics
NPI:1629347869
Name:GORDON, EILEEN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARIE
Other - Last Name:CREMERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3039
Practice Address - Street 1:40 N GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4107
Practice Address - Country:US
Practice Address - Phone:859-781-4900
Practice Address - Fax:859-572-3039
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X, 237700000X
KY0526231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist