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General NPI Number Information
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NPI Number | 1659674331
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Entity Type | Individual
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Provider Name | MARY GARDNER M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 14002 E 21ST ST SUITE 200
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City | TULSA
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State | OK
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Zip | 74134-1412
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Country | US
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Telephone | 918-299-1017
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Fax |
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Provider Business Mailing Address
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Address Line | 11242 S KINGSTON AVE
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City | TULSA
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State | OK
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Zip | 74137-7727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0470
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License Number State | OK
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