Individual
CLINTON GORDON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
216 OUACHITA AVE, MONROE, LA 71201-8513
(318) 322-4770
(318) 582-5096
Mailing address
216 OUACHITA AVE, MONROE, LA 71201-8513
(318) 322-4770
(318) 582-5096
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
5184
LA
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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