Provider Demographics
NPI:1457706285
Name:GORDON, JACQUELINE (BS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 LAKE FOREST BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3043
Mailing Address - Country:US
Mailing Address - Phone:504-241-8188
Mailing Address - Fax:504-264-5941
Practice Address - Street 1:9235 LAKE FOREST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3043
Practice Address - Country:US
Practice Address - Phone:504-241-8188
Practice Address - Fax:504-264-5941
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor