Provider Demographics
NPI:1043378375
Name:GARDNER, REX CLIFTON (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:CLIFTON
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:DR
Other - First Name:REX
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, MA, PHD
Mailing Address - Street 1:1070 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6905
Mailing Address - Country:US
Mailing Address - Phone:213-457-3387
Mailing Address - Fax:
Practice Address - Street 1:1107 BELLE VIEW BLVD APT B1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6629
Practice Address - Country:US
Practice Address - Phone:202-739-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist