Provider Demographics
NPI:1679703680
Name:GORDON, PATRICK ALFORD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ALFORD
Last Name:GORDON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 PLAINFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5343
Mailing Address - Country:US
Mailing Address - Phone:630-654-1377
Mailing Address - Fax:630-654-2575
Practice Address - Street 1:621 PLAINFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5343
Practice Address - Country:US
Practice Address - Phone:630-654-1377
Practice Address - Fax:630-654-2575
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009019103TC0700X
IN20042835A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099144001Medicare UPIN
NE47084125026Medicaid