Individual
DR. KENNETH STEVEN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
755 LAKEFIELD RD STE J, WESTLAKE VILLAGE, CA 91361-2639
(805) 491-2478
Mailing address
2650 BUGGY LN, SANTA ROSA VALLEY, CA 93012-9209
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1525
AZ
103T00000X
Psychologist
4749-PY-PY
MA
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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