Provider Demographics
NPI:1972962850
Name:GARDNER, CHRISTIE (AUD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:SYLVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 HIXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5329
Mailing Address - Country:US
Mailing Address - Phone:508-951-7434
Mailing Address - Fax:
Practice Address - Street 1:377 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2300
Practice Address - Country:US
Practice Address - Phone:508-951-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA965231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist