Individual
ISIASHA MARK GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
181 TOWN CREEK RD, AIKEN, SC 29803-5841
(803) 642-0700
(803) 642-0588
Mailing address
181 TOWN CREEK RD, AIKEN, SC 29803-5841
(803) 642-0700
(803) 642-0588
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5862
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5862
STATE LICENSE
SC
Enumeration date
09/24/2015
Last updated
08/24/2022
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