Provider Demographics
NPI:1710328620
Name:GORDON, ASHLEY KRISTEN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTEN
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 PHILIPPE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-3295
Mailing Address - Country:US
Mailing Address - Phone:912-596-6585
Mailing Address - Fax:
Practice Address - Street 1:4301 N FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 2 SOUTH BUTTERFLY EFFECTS LLC
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:954-342-0273
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist