Provider Demographics
NPI:1679555122
Name:GORDON, LINDA KAMSTRA (MA, LP, LADC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAMSTRA
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, LP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4651 NICOLS RD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3336
Mailing Address - Country:US
Mailing Address - Phone:651-688-3168
Mailing Address - Fax:651-688-3583
Practice Address - Street 1:4651 NICOLS RD
Practice Address - Street 2:SUITE 102A
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3336
Practice Address - Country:US
Practice Address - Phone:651-688-3168
Practice Address - Fax:651-688-3583
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP3677103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist