Provider Demographics
NPI:1528182086
Name:GARDNER, JAIME HEATHER (LMP, CHP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:HEATHER
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMP, CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 CAPITOL WAY S
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2833
Mailing Address - Country:US
Mailing Address - Phone:360-087-0265
Mailing Address - Fax:
Practice Address - Street 1:209 4TH AVENUE SUITE #214
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-870-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021255174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist