1144663816 NPI number — ELIZABETH ANN GORDON AU.D., CCC-A

Table of content: ELIZABETH ANN GORDON AU.D., CCC-A (NPI 1144663816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144663816 NPI number — ELIZABETH ANN GORDON AU.D., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRIS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144663816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11700 W 2ND PL
Provider Second Line Business Mailing Address:
SUITE 435
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80228-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-321-8410
Provider Business Mailing Address Fax Number:
720-321-8411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11700 W 2ND PL
Provider Second Line Business Practice Location Address:
SUITE 435
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-321-8410
Provider Business Practice Location Address Fax Number:
720-321-8411
Provider Enumeration Date:
04/12/2013

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: 231H00000X , with the licence number:  147.0011451 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AUD.0000727 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 320523735001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79251056 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com