Provider Demographics
NPI:1124357348
Name:GARDNER, JANE A (PHD, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHD, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 COLUMBIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1530
Mailing Address - Country:US
Mailing Address - Phone:440-235-2600
Mailing Address - Fax:440-235-2600
Practice Address - Street 1:7172 COLUMBIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1530
Practice Address - Country:US
Practice Address - Phone:440-235-2600
Practice Address - Fax:440-235-2600
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002077101YM0800X
OHOH1501310101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool