Provider Demographics
NPI:1407287899
Name:GARDNER, IVYE MARIE (MSW,LSW)
Entity Type:Individual
Prefix:MS
First Name:IVYE
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2004
Mailing Address - Country:US
Mailing Address - Phone:513-684-7968
Mailing Address - Fax:513-684-7963
Practice Address - Street 1:2534 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2004
Practice Address - Country:US
Practice Address - Phone:513-684-7968
Practice Address - Fax:513-684-7963
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0801013104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker