Individual
JESSICA R GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
S.2101975-TRNE
OH
1041C0700X
Clinical Social Worker
Primary
S.2207587
OH
171M00000X
Case Manager/Care Coordinator
S.2101975-TRNE
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0293452
—
OH
Enumeration date
06/14/2018
Last updated
08/22/2022
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