Provider Demographics
NPI:1689015067
Name:GORDON, ASHLEY BLAKE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BLAKE
Last Name:GORDON
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7310 MANCHACA RD
Mailing Address - Street 2:#150939
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-5001
Mailing Address - Country:US
Mailing Address - Phone:512-222-8515
Mailing Address - Fax:
Practice Address - Street 1:4201 WESTBANK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4454
Practice Address - Country:US
Practice Address - Phone:512-327-8877
Practice Address - Fax:512-327-0388
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0082246175F00000X
TXAC01608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist