Provider Demographics
NPI:1780698589
Name:GORDON, NANCY H (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:H
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 TRAILVIEW BLVD. SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:703-777-0561
Mailing Address - Fax:703-737-8235
Practice Address - Street 1:906 TRAILVIEW BLVD SE
Practice Address - Street 2:SUITE A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4415
Practice Address - Country:US
Practice Address - Phone:703-777-0561
Practice Address - Fax:703-737-8235
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA257110OtherMAMSI