Provider Demographics
NPI:1871652776
Name:GARDNER, BILL J
Entity Type:Individual
Prefix:MR
First Name:BILL
Middle Name:J
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3386
Mailing Address - Country:US
Mailing Address - Phone:415-775-6006
Mailing Address - Fax:415-474-9518
Practice Address - Street 1:240 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3386
Practice Address - Country:US
Practice Address - Phone:415-775-6006
Practice Address - Fax:415-474-9518
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health