MEDICARE: GINA GARDNER-WOOD

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265978787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA GARDNER-WOOD

Provider Business Mailing Address
First Line	:	11785 ZENOBIA LOOP
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-7850
Country	:	US
Telephone Number	:	720-270-9814
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 W 120TH AVE STE 400
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3493
Country	:	US
Telephone Number	:	720-370-1800
Fax Number	:

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

Provider Enumeration Date	:	01/07/2017
Last Update Date	:	09/17/2024

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