Provider Demographics
NPI:1821495292
Name:GORDINIER, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:GORDINIER
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 1:38777 6 MILE ROAD, SUITE 209
Mailing Address - Street 2:SUPPLEMENTAL HEALTH CARE
Mailing Address - City:LAVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:734-452-0395
Mailing Address - Fax:
Practice Address - Street 1:38777 6 MILE ROAD, SUITE 209
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:LAVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-452-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist