Provider Demographics
NPI:1306217708
Name:GARDNER, KATIE (MS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 5TH AVE
Mailing Address - Street 2:#1308
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2932
Mailing Address - Country:US
Mailing Address - Phone:206-468-9927
Mailing Address - Fax:
Practice Address - Street 1:2105 5TH AVE
Practice Address - Street 2:#1308
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2932
Practice Address - Country:US
Practice Address - Phone:206-468-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.6060052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist