Provider Demographics
NPI:1174282156
Name:GARDNER, ANN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W WOODBOUND DR APT B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4100
Mailing Address - Country:US
Mailing Address - Phone:717-512-0177
Mailing Address - Fax:
Practice Address - Street 1:3510 SILVERSIDE RD STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4937
Practice Address - Country:US
Practice Address - Phone:302-415-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist