Provider Demographics
NPI:1679773261
Name:GARDNER, DEBORAH E (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 LINDRICK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6627
Mailing Address - Country:US
Mailing Address - Phone:704-845-6852
Mailing Address - Fax:
Practice Address - Street 1:12728 LINDRICK LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6627
Practice Address - Country:US
Practice Address - Phone:704-845-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist