Provider Demographics
NPI:1134363955
Name:GARDNER, CHANTEL JASMINE
Entity type:Individual
Prefix:MS
First Name:CHANTEL
Middle Name:JASMINE
Last Name:GARDNER
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 1:8670 FAIR OAKS BLVD APT 28
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2561
Mailing Address - Country:US
Mailing Address - Phone:916-338-1001
Mailing Address - Fax:
Practice Address - Street 1:6833 STOCKTON BLVD
Practice Address - Street 2:SUITE 485
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2372
Practice Address - Country:US
Practice Address - Phone:916-394-0800
Practice Address - Fax:916-429-7824
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker