Provider Demographics
NPI:1700931169
Name:GARDNER, SARAH L (LAC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14720 107TH WAY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-3827
Mailing Address - Country:US
Mailing Address - Phone:206-940-8802
Mailing Address - Fax:
Practice Address - Street 1:17917 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5204
Practice Address - Country:US
Practice Address - Phone:206-940-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000237171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist