Provider Demographics
NPI:1306360508
Name:GARDNER, CASSANDRA MICHELLE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MICHELLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5107
Mailing Address - Country:US
Mailing Address - Phone:971-237-7390
Mailing Address - Fax:
Practice Address - Street 1:63159 BOYD ACRES RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8516
Practice Address - Country:US
Practice Address - Phone:541-854-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional