Provider Demographics
NPI:1528889011
Name:GORDON, LANELL
Entity type:Individual
Prefix:
First Name:LANELL
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13827 NW 155TH LN
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5886
Mailing Address - Country:US
Mailing Address - Phone:352-327-8571
Mailing Address - Fax:
Practice Address - Street 1:13827 NW 155TH LN
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5886
Practice Address - Country:US
Practice Address - Phone:352-327-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services