IndividualActive
Wade Gordon, LCSW
NPI 1376740134 · Clinical Social Worker · Rexburg, ID
Provider details
- NPI number
- 1376740134
- Entity type
- Individual
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- License
- LCSW-27205 (ID)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
310 N 2nd E
Suite 128
Rexburg, ID 83440-1600
Phone: (208) 356-5675
Fax: (208) 356-5675
Street-level locationGet directions
Mailing address
310 N 2nd E
Rexburg, ID 83440-1600
Registry dates
- Enumerated
- 2007-06-27
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.