Provider Demographics
NPI:1912052325
Name:GORDY, PAULA SUE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:SUE
Last Name:GORDY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20501 BLUE GOOSE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-4102
Mailing Address - Country:US
Mailing Address - Phone:660-457-3078
Mailing Address - Fax:
Practice Address - Street 1:501 N 12TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1439
Practice Address - Country:US
Practice Address - Phone:641-856-2688
Practice Address - Fax:641-856-2690
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0047021041C0700X
IA012941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical