Healthcare Provider Details

I. General information

NPI: 1093837700
Provider Name (Legal Business Name): LYNDA GARDNER MA, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 MEADOW LARK CT
MILFORD OH
45150-2286
US

IV. Provider business mailing address

5907 MEADOW LARK CT
MILFORD OH
45150-2286
US

V. Phone/Fax

Practice location:
  • Phone: 513-575-2271
  • Fax: 513-575-2463
Mailing address:
  • Phone: 513-575-2271
  • Fax: 513-575-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00015668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: