Provider Demographics
NPI:1457555096
Name:GARDNER, DIANE GANDY (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:GANDY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 CORAL BAY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9196
Mailing Address - Country:US
Mailing Address - Phone:317-823-0698
Mailing Address - Fax:
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8419
Practice Address - Country:US
Practice Address - Phone:720-455-3800
Practice Address - Fax:720-455-3801
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0001003231H00000X
IN23002124A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist