Provider Demographics
NPI:1720163611
Name:GORDON, WENDY M (DM, MPH, CPM, LM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:DM, MPH, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3707
Mailing Address - Country:US
Mailing Address - Phone:206-407-3397
Mailing Address - Fax:206-316-8322
Practice Address - Street 1:1500 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3707
Practice Address - Country:US
Practice Address - Phone:206-407-3397
Practice Address - Fax:206-316-8322
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000314176B00000X
ORDEM-LD-1008702176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8487332Medicaid