Provider Demographics
NPI:1518216605
Name:GARDNER, MARIA RODRIGUEZ (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:RODRIGUEZ
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARIA LUZ
Other - Middle Name:RODRIGUEZ
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1007 39TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2192
Mailing Address - Country:US
Mailing Address - Phone:253-435-3100
Mailing Address - Fax:253-535-3138
Practice Address - Street 1:1007 39TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2192
Practice Address - Country:US
Practice Address - Phone:253-435-3100
Practice Address - Fax:253-435-3138
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490214951041C0700X
WALW611117861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical