Provider Demographics
NPI:1871394718
Name:GORDON PEDIATRIC SPEECH THERAPY LLC
Entity type:Organization
Organization Name:GORDON PEDIATRIC SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, PI
Authorized Official - Phone:215-313-0551
Mailing Address - Street 1:6006 CANNON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1802
Mailing Address - Country:US
Mailing Address - Phone:215-313-0551
Mailing Address - Fax:
Practice Address - Street 1:6006 CANNON HILL RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1802
Practice Address - Country:US
Practice Address - Phone:215-313-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty