1508948951 NPI number — MRS. SUSAN LINDER GORDON MED LPC

Table of content: MRS. SUSAN LINDER GORDON MED LPC (NPI 1508948951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508948951 NPI number — MRS. SUSAN LINDER GORDON MED LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
SUSAN
Provider Middle Name:
LINDER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508948951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6365 CLAYTON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-646-0487
Provider Business Mailing Address Fax Number:
314-646-0351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6365 CLAYTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-646-0487
Provider Business Practice Location Address Fax Number:
314-646-0351
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  CS001099 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 622439 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23331 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 561150 . This is a "HEALTHLINK NON PAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043152196701 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129174 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".




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