MEDICARE: ALYSIA GARDNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1124426549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSIA GARDNER

Provider Business Mailing Address
First Line	:	3909 SWEET PINE ST UNIT 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8131
Country	:	US
Telephone Number	:	702-788-6445
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 SWEET PINE ST UNIT 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8131
Country	:	US
Telephone Number	:	702-788-6445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	12/17/2014

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Directions to “ ALYSIA GARDNER ” Practice Location

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