Provider Demographics
NPI:1740602366
Name:GARDELIN-ENGLUND, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:GARDELIN-ENGLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 SPENCER ST
Mailing Address - Street 2:#118
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-9303
Mailing Address - Country:US
Mailing Address - Phone:702-799-9710
Mailing Address - Fax:702-799-9712
Practice Address - Street 1:4055 SPENCER ST
Practice Address - Street 2:#118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-9303
Practice Address - Country:US
Practice Address - Phone:702-799-9710
Practice Address - Fax:702-799-9712
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor