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Individual
MR. SILAS KENNY GORDON
Active
Individual
MR. SILAS KENNY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN, AAC
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CG61049487
WA
164W00000X
Licensed Practical Nurse
LP60623702
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP 60623702
STATE NURSING LICENSE
WA
Enumeration date
01/05/2017
Last updated
03/02/2020
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