Individual
MEGAN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
327 COLLEGE AVE, SANTA ROSA, CA 95401-5117
(707) 568-2800
Mailing address
2390 DONNA MARIA WAY, SANTA ROSA, CA 95401-5789
(707) 696-2725
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT22049
CA
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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