Provider Demographics
NPI:1821134834
Name:GORDON, BRIDGET MOSS (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:MOSS
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11722 WEST MARIPOSA GRANDE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373
Mailing Address - Country:US
Mailing Address - Phone:623-444-5207
Mailing Address - Fax:623-974-8911
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4828
Practice Address - Country:US
Practice Address - Phone:623-974-8900
Practice Address - Fax:623-974-8911
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0913750OtherBLUE CROSS BLUE SHIELD AZ