Provider Demographics
NPI:1255125506
Name:GORDON, JENILEE
Entity type:Individual
Prefix:MISS
First Name:JENILEE
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 1:3604 HIBISCUS PL
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4934
Mailing Address - Country:US
Mailing Address - Phone:561-305-0715
Mailing Address - Fax:
Practice Address - Street 1:3604 HIBISCUS PL
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4934
Practice Address - Country:US
Practice Address - Phone:561-305-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst