Provider Demographics
NPI:1659560688
Name:GAERDITZ, IRIS LADAWN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:LADAWN
Last Name:GAERDITZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:IRIS
Other - Middle Name:LADAWN
Other - Last Name:MCLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29754 JOCKEY ST
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MO
Mailing Address - Zip Code:63549-4008
Mailing Address - Country:US
Mailing Address - Phone:660-346-1338
Mailing Address - Fax:
Practice Address - Street 1:702 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552
Practice Address - Country:US
Practice Address - Phone:660-385-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist