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Individual

DR. LISA BETH GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
618 LIBRARY PLACE, EVANSTON, IL 60201-2908
(847) 733-4300
(847) 733-0390
Mailing address
618 LIBRARY PLACE, EVANSTON, IL 60201-2908
(847) 733-4300
(847) 733-0390

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PY6692
FL
103TC0700X
Clinical Psychologist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
U26622
FL
Enumeration date
02/20/2008
Last updated
02/20/2008
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