Provider Demographics
NPI:1093014375
Name:GARDNER, AUDRIE A (LISW)
Entity Type:Individual
Prefix:
First Name:AUDRIE
Middle Name:A
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7265 KENWOOD ROAD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4411
Mailing Address - Country:US
Mailing Address - Phone:513-657-8718
Mailing Address - Fax:
Practice Address - Street 1:7265 KENWOOD ROAD
Practice Address - Street 2:SUITE 321
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4411
Practice Address - Country:US
Practice Address - Phone:513-657-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14507571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical