Provider Demographics
NPI:1447523972
Name:GORDON, MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9748
Mailing Address - Country:US
Mailing Address - Phone:360-426-7788
Mailing Address - Fax:360-877-2035
Practice Address - Street 1:80 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-9748
Practice Address - Country:US
Practice Address - Phone:360-426-7788
Practice Address - Fax:360-877-2035
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000088801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical