Provider Demographics
NPI:1841079209
Name:GORDON, LINDA (CD(DONA))
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17213 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3624
Mailing Address - Country:US
Mailing Address - Phone:708-710-2528
Mailing Address - Fax:
Practice Address - Street 1:17213 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3624
Practice Address - Country:US
Practice Address - Phone:708-710-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 251S00000X
IL15102374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator
No251S00000XAgenciesCommunity/Behavioral Health