Provider Demographics
NPI:1619282928
Name:GORDON, LASAUNDRA D (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:LASAUNDRA
Middle Name:D
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 177TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1722
Mailing Address - Country:US
Mailing Address - Phone:708-895-7310
Mailing Address - Fax:
Practice Address - Street 1:2325 177TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1722
Practice Address - Country:US
Practice Address - Phone:708-895-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional