MEDICARE: CASSANDRA MICHELLE 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	101YP2500X	Professional Counselor	C6598	OR

General Provider Information

NPI Number	:	1306360508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA MICHELLE GARDNER

Provider Business Mailing Address
First Line	:	643 NW 6TH CT
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-5107
Country	:	US
Telephone Number	:	971-237-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	63159 BOYD ACRES RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-8516
Country	:	US
Telephone Number	:	541-854-5324
Fax Number	:

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

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	09/19/2023

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