Provider Demographics
NPI:1841305711
Name:GORDON, GAIL F (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:F
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2835
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:636-949-8861
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:SUITE 390
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:636-949-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0008491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO180069OtherBLUE CROSS BLUE SHIELD