MEDICARE: TRACY 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	235Z00000X	Speech-Language Pathologist	5663	NM

General Provider Information

NPI Number	:	1891183448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY GARDNER

Provider Business Mailing Address
First Line	:	5987 DUNRAVEN ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-1007
Country	:	US
Telephone Number	:	720-238-3532
Fax Number	:

Provider Business Practice Location Address
First Line	:	5987 DUNRAVEN ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-1007
Country	:	US
Telephone Number	:	720-238-3532
Fax Number	:

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

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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Directions to “ TRACY GARDNER ” Practice Location

Language	Start Address	Practice Location

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