Provider Demographics
NPI:1144663816
Name:GORDON, ELIZABETH ANN (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:SUITE 435
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1704
Mailing Address - Country:US
Mailing Address - Phone:720-321-8410
Mailing Address - Fax:720-321-8411
Practice Address - Street 1:11700 W 2ND PL
Practice Address - Street 2:SUITE 435
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1704
Practice Address - Country:US
Practice Address - Phone:720-321-8410
Practice Address - Fax:720-321-8411
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.0011451231H00000X
COAUD.0000727231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320523735001Medicaid
CO79251056Medicaid
CO382430YMMWMedicare PIN
CO79251056Medicaid