Provider Demographics
NPI:1033863097
Name:GARDNER, DELANEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S RIVER RD APT 17
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1611
Mailing Address - Country:US
Mailing Address - Phone:330-420-8801
Mailing Address - Fax:
Practice Address - Street 1:3807 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1630
Practice Address - Country:US
Practice Address - Phone:330-664-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist