Individual
MS. JUDI MARIE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, LADC
Contact information
Practice address
1911 PLEASANT AVE. SOUTH, CREATE, INC, MINNEAPOLIS, MN 55403
(612) 874-9811
(612) 874-9820
Mailing address
1911 PLEASANT AVE. SOUTH, CREATE, INC, MINNEAPOLIS, MN 55403
(612) 874-9811
(612) 874-9820
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300170
MN
163W00000X
Registered Nurse
R-062487-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300170
LADC
MN
01
—
R-062487-1
REGISTERED NURSE
MN
Enumeration date
01/22/2008
Last updated
01/22/2008
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