Provider Demographics
NPI:1972193258
Name:GORDON, CELESTE AMARI
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:AMARI
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 1:14317 W 53RD TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-5190
Mailing Address - Country:US
Mailing Address - Phone:913-687-7877
Mailing Address - Fax:
Practice Address - Street 1:17210 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-8901
Practice Address - Country:US
Practice Address - Phone:913-777-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician