Provider Demographics
NPI:1053648873
Name:GARDNER, MEREDITH REA (BCABA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:REA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 HYCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3841
Mailing Address - Country:US
Mailing Address - Phone:502-500-9507
Mailing Address - Fax:502-458-4694
Practice Address - Street 1:4008 HYCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3841
Practice Address - Country:US
Practice Address - Phone:502-500-9507
Practice Address - Fax:502-458-4694
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst