Individual
JANICE L GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1133 COLOMA WAY, ROSEVILLE, CA 95661-4480
(916) 774-6647
Mailing address
14264 NOJACK CT, PENN VALLEY, CA 95946-9731
(530) 615-9995
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33828
CA
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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