Provider Demographics
NPI:1821338054
Name:GORDON, REBECCA SUSAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUSAN
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 1:7575 E ARKANSAS AVE
Mailing Address - Street 2:BUILDING 10 SUITE 208
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2500
Mailing Address - Country:US
Mailing Address - Phone:913-744-9411
Mailing Address - Fax:
Practice Address - Street 1:456 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5126
Practice Address - Country:US
Practice Address - Phone:303-504-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health