Provider Demographics
NPI:1093226169
Name:GARDULL, RACHEL PATRICIA (LISW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:PATRICIA
Last Name:GARDULL
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 1:4532 289TH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3454 OAK ALLEY CT STE 201
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1370
Practice Address - Country:US
Practice Address - Phone:330-401-1416
Practice Address - Fax:855-761-1502
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker