Provider Demographics
NPI:1811419542
Name:GARDNER, SYDNEY SANDERS (SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SANDERS
Last Name:GARDNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:JANE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 TOWN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5841
Mailing Address - Country:US
Mailing Address - Phone:803-642-0700
Mailing Address - Fax:803-642-0588
Practice Address - Street 1:181 TOWN CREEK RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-642-0700
Practice Address - Fax:803-642-0588
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist