Individual
JACQUELINE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3800 S NATIONAL AVE STE 700, SPRINGFIELD, MO 65807-5279
(417) 269-8817
(417) 269-8744
Mailing address
3800 S NATIONAL AVE STE 700, SPRINGFIELD, MO 65807-5279
(417) 269-8817
(417) 269-8744
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01758
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498214014
—
MO
Enumeration date
06/24/2005
Last updated
01/12/2023
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