Individual
SUSAN THERESA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
4227 9TH AVE SW, FARGO, ND 58103-2018
(701) 282-6561
Mailing address
715 11TH ST N, MOORHEAD, MN 56560-2083
(218) 233-6398
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301445
LADC
MN
Enumeration date
09/18/2007
Last updated
09/18/2007
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