Provider Demographics
NPI:1861616120
Name:GORDON, BRIDGET MARGARET (LICSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARGARET
Last Name:GORDON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 D ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3101
Mailing Address - Country:US
Mailing Address - Phone:360-647-2616
Mailing Address - Fax:360-671-1842
Practice Address - Street 1:1712 D ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3101
Practice Address - Country:US
Practice Address - Phone:360-647-2616
Practice Address - Fax:360-671-1842
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000068731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB35497Medicare ID - Type Unspecified