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NPI Code Detail

MEDICARE: MRS. DIANE GANDY GARDNER M.S., CCC-A

MEDICARE: MRS. DIANE GANDY GARDNER M.S., CCC-A
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
1231H00000XAudiologistAUD.0001003CO
2231H00000XAudiologist23002124AIN

General Provider Information

NPI Number : 1457555096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE GANDY GARDNER M.S., CCC-A
Provider Business Mailing Address
First Line : 8336 CORAL BAY CT
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46236-9196
Country : US
Telephone Number : 317-823-0698
Fax Number :
Provider Business Practice Location Address
First Line : 2352 MEADOWS BLVD STE 300
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-8419
Country : US
Telephone Number : 720-455-3800
Fax Number : 720-455-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2007
Last Update Date : 03/07/2022

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