Provider Demographics
NPI:1952018913
Name:GARDNER, SHERIKA ANTIONETTE (PLMHP)
Entity Type:Individual
Prefix:
First Name:SHERIKA
Middle Name:ANTIONETTE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3629
Mailing Address - Country:US
Mailing Address - Phone:531-375-5646
Mailing Address - Fax:
Practice Address - Street 1:7810 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3629
Practice Address - Country:US
Practice Address - Phone:531-375-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health