Individual
MICHAEL HAYES GORDON
Active
Individual
MICHAEL HAYES GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003058
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196615
BLUE SHIELD/BLUE CHOICE
MO
05
—
497286310
—
MO
01
—
695629
HEALTHLINK
MO
Enumeration date
05/04/2006
Last updated
10/15/2007
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