Provider Demographics
NPI:1356974349
Name:GORDON, HADLEY (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:HADLEY
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 SHERIDAN BLVD STE 315C
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6160
Mailing Address - Country:US
Mailing Address - Phone:708-717-7394
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 315C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-6160
Practice Address - Country:US
Practice Address - Phone:708-717-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10632133V00000X
GALD005885133V00000X
390200000X
CO133V00000X
WY376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program