Individual
MR. EITAN M GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.S.
Contact information
Practice address
1810 N GRANT ST, LEBANON, IN 46052-1242
(773) 742-2487
Mailing address
1810 N GRANT ST, LEBANON, IN 46052-1242
(765) 483-3090
(765) 483-3087
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
10283464
IN
Other
Enumeration date
01/24/2018
Last updated
10/28/2024
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