Individual
JACQUELINE ANN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7301 POE AVE, DAYTON, OH 45414-2559
(937) 280-4631
Mailing address
7301 POE AVE, DAYTON, OH 45414-2559
(937) 280-4631
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
161448
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161448
—
OH
Enumeration date
06/07/2018
Last updated
06/16/2018
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