Healthcare Provider Details

I. General information

NPI: 1346155082
Provider Name (Legal Business Name): FAITH GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 VINEYARD DR
TEMPLETON CA
93465-9412
US

IV. Provider business mailing address

286 VIA LA PAZ
SAN LUIS OBISPO CA
93401-6961
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-2081
  • Fax:
Mailing address:
  • Phone: 805-503-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: