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NPI Code Detail

MEDICARE: CEAN GARDNER

MEDICARE: CEAN 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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1578123899
Entity Type Code : Individual
Provider Name (Legal Business Name) : CEAN GARDNER
Provider Business Mailing Address
First Line : 206 S RONEY ST
Second Line :
City : CARL JUNCTION
State : MO
Zip : 64834-9402
Country : US
Telephone Number : 417-649-5714
Fax Number :
Provider Business Practice Location Address
First Line : 206 S RONEY ST
Second Line :
City : CARL JUNCTION
State : MO
Zip : 64834-9402
Country : US
Telephone Number : 417-649-5714
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 06/18/2019

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Directions to “ CEAN GARDNER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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