Provider Demographics
NPI:1821125378
Name:GARDNER, JESSICA A (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:GARDNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11008 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5694
Mailing Address - Country:US
Mailing Address - Phone:865-712-1359
Mailing Address - Fax:
Practice Address - Street 1:11008 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5694
Practice Address - Country:US
Practice Address - Phone:865-712-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer