Provider Demographics
NPI:1881007375
Name:GORDON, CIERRA HOLLY (MS, SLP)
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:HOLLY
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MILLER ST
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2508
Mailing Address - Country:US
Mailing Address - Phone:661-477-1634
Mailing Address - Fax:
Practice Address - Street 1:131 MILLER ST
Practice Address - Street 2:MEDICAL CENTER BOULEVARD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2508
Practice Address - Country:US
Practice Address - Phone:661-477-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist