Provider Demographics
NPI:1871870774
Name:GORDON, PEGGY LEE
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LEE
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:LEE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:450 OURAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2536
Practice Address - Country:US
Practice Address - Phone:970-241-6099
Practice Address - Fax:970-241-0797
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor