Provider Demographics
NPI:1518176619
Name:GARDNER, LORRAINE KLEIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:KLEIN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 PATTERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3400
Mailing Address - Country:US
Mailing Address - Phone:804-282-5590
Mailing Address - Fax:804-282-5593
Practice Address - Street 1:6722 PATTERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3400
Practice Address - Country:US
Practice Address - Phone:804-282-5590
Practice Address - Fax:804-282-5593
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000125231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist