Provider Demographics
NPI:1831945906
Name:GORDON, AUDREY CLARK (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:CLARK
Last Name:GORDON
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-0651
Mailing Address - Country:US
Mailing Address - Phone:337-781-5914
Mailing Address - Fax:
Practice Address - Street 1:14340 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441-5213
Practice Address - Country:US
Practice Address - Phone:337-781-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist