Provider Demographics
NPI:1790040061
Name:GARDNER, ROBERT II (MASTER DEGREE)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GARDNER
Suffix:II
Gender:M
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 W 85TH PL
Mailing Address - Street 2:10336 SOUTH WESTERN AVE.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3756
Mailing Address - Country:US
Mailing Address - Phone:773-891-8847
Mailing Address - Fax:773-778-2758
Practice Address - Street 1:3251 W 85TH PL
Practice Address - Street 2:10336 SOUTH WESTERN AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3756
Practice Address - Country:US
Practice Address - Phone:773-891-8847
Practice Address - Fax:773-778-2758
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health